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Cardiovascular disease is the most common cause of mortality worldwide and a major public health concern, with the majority of cardiovascular deaths attributable to coronary artery disease. Acute coronary syndrome (ACS) is an ominous manifestation of coronary artery disease and a spectrum of myocardial ischemia ranging from angina with reversible tissue damage to myocardial infarction (MI) with tissue necrosis. Timely and accurate diagnosis of ACS is crucial for initiating early treatment and missed diagnosis may have serious consequences. Biochemical cardiac markers include proteins released from the injured myocardium into the circulation and have long been used for aiding in the diagnosis and risk stratification of ACS. Over the past decades, cardiac biomarkers have evolved greatly from the earlier markers with less myocardium selectivity to later highly cardiac‐specific markers. In addition, the advance in technology has allowed for continuing improvement of analytical sensitivity of cardiac biomarker assays. The increased sensitivity has revolutionized ACS diagnosis by facilitating earlier detection of biomarker rise, shorter time intervals for serial measurements, and faster patient triage in emergency departments. This chapter describes the current definition of MI and its latest diagnostic guidelines, with a focus on cardiac troponin and the new generation of high‐sensitivity cardiac troponin (hs‐cTn) assays as the preferred cardiac marker. Development of optimal diagnostic algorithms, factors affecting the performance of these algorithms, and alternative diagnostic protocols are discussed. In addition, historical cardiac markers and novel markers with their potential advantages are reviewed.
Cardiovascular disease is the most common cause of mortality worldwide and a major public health concern, with the majority of cardiovascular deaths attributable to coronary artery disease. Acute coronary syndrome (ACS) is an ominous manifestation of coronary artery disease and a spectrum of myocardial ischemia ranging from angina with reversible tissue damage to myocardial infarction (MI) with tissue necrosis. Timely and accurate diagnosis of ACS is crucial for initiating early treatment and missed diagnosis may have serious consequences. Biochemical cardiac markers include proteins released from the injured myocardium into the circulation and have long been used for aiding in the diagnosis and risk stratification of ACS. Over the past decades, cardiac biomarkers have evolved greatly from the earlier markers with less myocardium selectivity to later highly cardiac‐specific markers. In addition, the advance in technology has allowed for continuing improvement of analytical sensitivity of cardiac biomarker assays. The increased sensitivity has revolutionized ACS diagnosis by facilitating earlier detection of biomarker rise, shorter time intervals for serial measurements, and faster patient triage in emergency departments. This chapter describes the current definition of MI and its latest diagnostic guidelines, with a focus on cardiac troponin and the new generation of high‐sensitivity cardiac troponin (hs‐cTn) assays as the preferred cardiac marker. Development of optimal diagnostic algorithms, factors affecting the performance of these algorithms, and alternative diagnostic protocols are discussed. In addition, historical cardiac markers and novel markers with their potential advantages are reviewed.
Periprocedural myocardial infarction (PMI) and injury, pertinent to both cardiac and non-cardiac procedures, have gained increasing recognition in clinical practice. Over time, diverse definitions for diagnosing PMI have been developed and validated among patient populations undergoing coronary revascularization. However, this variety in definitions presents considerable challenges in clinical settings and complicates both the design and interpretation of clinical trials. The necessity to accurately diagnose PMI has spurred significant interest in establishing universally accepted and prognostically meaningful thresholds for cardiac biomarkers elevation and supportive ancillary criteria. In fact, elevations in cardiac biomarkers in line with the 4th Universal Definition of Myocardial Infarction, have been extensively confirmed to be associated with increased mortality and cardiovascular events. In the context of non-coronary cardiac procedures, such as Transcatheter Aortic Valve Implantation, there is a growing acknowledgment of both the high incidence rates and the adverse impact of PMI on patient outcomes. Similarly, emerging research underscores the significance of PMI and injury in non-cardiac surgery, highlighting the urgent need for effective prevention and risk management strategies in this domain.
Non-ST Elevation Myocardial Infarction is a critical condition where early identification of myocardial injury is essential for risk stratification and treatment. High-sensitivity cardiac troponin I (hs-cTnI) is a well-established biomarker for detecting myocardial damage. Objectives: To assess the association between Syntax scores and initial significant delta hs-cTnI in patients who had been hospitalized with Non-ST Elevation Myocardial Infarction. Methods: Observational cohort study from January 2022 to December 2022 involving a total of one hundred and fifty patients admitted at Hayatabad Medical Complex Peshawar. hs-cTnI on admission and at 1, 2 hours and between (6h-12 h) post-admission daily was measured. Coronary lesion complexity was assessed with Syntax scores according to the results of coronary angiography. Statistical Analysis of data was performed using Pearson correlation to analyze the association between syntax scores delta hs-cTnI levels. Results: SYNTAX scores were correlated with Δhs-cTnI levels at all-time points, and the strongest correlation was found 6-12 hours post-admission (r=0.78). The syntax score had a mean value of 24.11 ± 14.74, and hs-cTnI levels increased over time to reflect the extent of myocardial injury. Conclusions: It was concluded that in Non-ST Elevation Myocardial Infarction patients, Syntax scores demonstrating more complex coronary lesions are related to higher delta hs-cTnI levels. This value highlights the use of hs-cTnI as a biomarker to evaluate the severity of myocardial injury and direct clinical decision-making in Non-ST Elevation Myocardial Infarction. Delta hs-cTnI measurements in diagnostic and risk stratification algorithms may lead to enhanced early identification of disease with improved outcomes.
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