Novel Biomarkers and Their Role in the Diagnosis and Prognosis of Acute Coronary Syndrome

Abstract

The burden of cardiovascular diseases and the critical role of acute coronary syndrome (ACS) in their progression underscore the need for effective diagnostic and prognostic tools. Biomarkers have emerged as crucial instruments for ACS diagnosis, risk stratification, and prognosis assessment. Among these, high-sensitivity troponin (hs-cTn) has revolutionized ACS diagnosis due to its superior sensitivity and negative predictive value. However, challenges regarding specificity, standardization, and interpretation persist. Beyond troponins, various biomarkers reflecting myocardial injury, neurohormonal activation, inflammation, thrombosis, and other pathways are being explored to refine ACS management. This review article comprehensively explores the landscape of clinically used biomarkers intricately involved in the pathophysiology, diagnosis, and prognosis of ACS (i.e., troponins, creatine kinase MB (CK-MB), B-type natriuretic peptides (BNP), copeptin, C-reactive protein (CRP), interleukin-6 (IL-6), d-dimers, fibrinogen), especially focusing on the prognostic role of natriuretic peptides and of inflammatory indices. Research data on novel biomarkers (i.e., endocan, galectin, soluble suppression of tumorigenicity (sST2), microRNAs (miRNAs), soluble oxidized low-density lipoprotein receptor-1 (sLOX-1), F2 isoprostanes, and growth differentiation factor 15 (GDF-15)) are further analyzed, aiming to shed light on the multiplicity of pathophysiologic mechanisms implicated in the evolution of ACS. By elucidating the complex interplay of these biomarkers in ACS pathophysiology, diagnosis, and outcomes, this review aims to enhance our understanding of the evolving trajectory and advancements in ACS management. However, further research is necessary to establish the clinical utility and integration of these biomarkers into routine practice to improve patient outcomes.

A Retrospective Study of Whether Sacubitril–Valsartan Improves Cardiac Function in Patients with Acute Coronary Syndrome and Hypertension after Percutaneous Coronary Intervention

“…In patients with ACS, the obstruction or spasm of coronary arteries can cause myocardial cells to be damaged by ischemia, hypoxia, or necrosis, resulting in elevated levels of CK-MB. Therefore, monitoring the level of CK-MB can serve as a major index to assess the extent of myocardial injury and prognosis [27]. After medication intervention in this study, the NT-proBNP, cTnI, and CK-MB levels in the observation group decreased compared with those in the control group.…”

The Role of Oxidative Stress and Inflammatory Parameters in Heart Failure

“…F2-Isoprostanes F2-Isoprostanes (IsoPs), generated from arachidonic acid breakdown, are detected in various cellular contexts, notably in monocytes during atherosclerosis driven by oxidative stress [88][89][90][91]. Elevated levels of IsoPs have been observed in the urine of individuals with unstable angina, indicating their potential as biomarkers for prognosticating complications in nonfatal myocardial infarction and HF progression [88]. IsoPs are primarily derived from tissue phospholipids and undergo hydrolysis to their free acid form, with subsequent metabolism, predominantly in the liver, and excretion in urine [90,91].…”

Assessing cardiac function post chemotherapy combined with immune checkpoint inhibitors via automated two-dimensional speckle tracking

“…This indicator initially increased and then decreased in this group of patients, similar to the results of a previous study 19 . Creatine kinase is a highly sensitive marker of myocardial injury that appears earlier in myocarditis than troponin 20 . Higher CK-MB levels were associated with increased mortality.…”