Table 1.
Biomarkers used and application in ACS.
| Biomarker | Mechanism of Action-Release | Clinical Application & Abilities |
|---|---|---|
| hs-Troponin | Regulates cardiac contraction. Released at myocardium necrosis. T & I isoforms cardiac specific |
Modification above 99th URL diagnostic for MI hs-cTn has high sensitivity & NPV at cost of specificity. 5x URL increase→high PPV (>90%) for type 1 MI ‘Rule-out’ & ‘rule-in’ MI algorithms Differentiate NSTEMI & UA Rises in 3–12 h, peak at 24 h. Prognosis of all-cause mortality |
| CK-MB | Released at myocardium necrosis. CK-MB isoenzyme mostly at cardiac muscle (low levels in skeletal muscle) |
Diagnosis: Rises after 4–6 h & peaks at 24 h Normal at 48–72 h→detects reinfarction. NPV 97% & sensitivity 91% at first 6 h Prognostic for infarct size, wall motion abnormalities, mortality, HF, possibly LV remodeling, CI-AKI |
| Cystatin C | Protease inhibitor secreted by nucleated cells. Filtered through glomerulus and catabolized in proximal tubule. Associated with Egfr |
Prognostic/risk stratification for all-cause mortality, HF hospitalization, CVD after ACS Peaks at 3rd day after ACS (vs. 6th Creatinine) Prognostic for NRP, MACE & mortality after PCI |
| H-FABP | Released from cytoplasm after cardiac injury and necrosis | High sensitivity at decreased cutoffs (4 μg/L) Early biomarker (<1 h), reinfarction detection Possible value in early ruling out MI |
| Endocan | Endothelial dysfunction & activation Inflammation |
Risk stratification and Prognosis of MACE, high SYNTAX score Possibly indicates reperfusion after PCI or CABG Possibly different levels in STEMI vs. NSTEMI/UA |
| Galectin | Cardiac remodeling and fibrosis (fibroblasts→myofibroblasts & collagen synthesis) Plaque Destabilization in CVD |
Prognosis of MI and HF Risk stratification (LVEF, MACE, mortality, HF, remodeling) Interrelated with atherosclerosis & inflammation. Possible therapeutic target |
| sST2 | Decoy receptor for sST2/IL-33 interaction cardiac fibrosis, hypertrophy and remodeling | Prognostic factor ADHF (>35 ng/mL) Therapeutic guidance in Type 1 & 2 MI (>35 ng/mL likely adverse remodeling & >70 ng/mL aggressive treatment) Prognostic for ACS (mortality, HF, remodeling) Prognostic for reperfusion & NRP after PCI |
| D-dimers | Breakdown of fibrin clot by plasmin at the site of coronary artery thrombosis | Possibly diagnostic for MI and differentiate from UA (>500 ng/mL) Prognostic for recurring MI, all-cause mortality, in hospital complications, NRP |
| CRP | Acute-phase inflammation | Prognostic factor of future myocardial infarction and stroke, levels > 3 mg/L upon discharge: increased risk of readmission within 1 year for recurrent cardiovascular instability or myocardial infarction |
| micro-RNA | Control of gene expression, oxidative stress, inflammation, apoptosis, fibrosis, and cardiac remodeling processes | Predictive factor for cardiovascular mortality and the development of heart failure |
| GDF-15 | Increases in tissue damage and inflammation | Risk predictor |
| Fibrinogen | Clot formation, platelet aggregation, fibrinolysis, inflammation | Induce coronary artery restenosis, baseline levels: increased risk of cardiovascular events within 2 years |
ACS: Acute Coronary Syndrome; ADHF: Acute Decompensated Heart Failure; CABG: Coronary Artery Bypass Grafting; CI-AKI: Contrast Induced Acute Kidney Injury; CK-MB: Creatine Kinase-MB; CVD: Cardiac Vascular Disease; eGFR: estimated Glomerular Filtration Rate; GDF-15: Growth Differentiation Factor-15; HF: Heart failure; hs-cTn: high sensitivity troponin; LV: Left Ventricle; MACE: Major Adverse Cardiac Events; MI: Myocardial Infarction; NSTEMI: non-ST-elevation Myocardial Infarction; NPV: Negative Predictive Value NRP: No Reflow Phenomenon; PCI: Percutaneous Coronary Intervention; PPV: Positive Predictive Value; UA: Unstable Angina; URL: Upper Reference Limit.