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Review
. 2017 Apr;19(4):29.
doi: 10.1007/s11886-017-0840-3.

Prognostic Biomarkers in Acute Coronary Syndromes: Risk Stratification Beyond Cardiac Troponins

K M Eggers  1 , B Lindahl  2
Affiliations
Review

Prognostic Biomarkers in Acute Coronary Syndromes: Risk Stratification Beyond Cardiac Troponins

K M Eggers et al. Curr Cardiol Rep. 2017 Apr.

Abstract

Purpose of review: Cardiac troponin (cTn) plays an essential role for assessment of outcome in acute coronary syndrome (ACS). However, the prognostic value of cTn is not absolute. In this mini-review, we summarize the evidence on the utility of established biomarkers of left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction for risk prediction beyond cTn in ACS.

Recent findings: Only few biomarkers consistently demonstrate additive prognostic value to cTn levels. The B-type natriuretic peptides (NPs) and growth-differentiation factor-15 (GDF-15) are most promising in this regard. However, there are uncertainties regarding the role of these biomarkers for guidance of treatment decisions, and their prognostic increment to cTn levels measured with high-sensitivity assays is largely unknown. The NPs and GDF-15 provide the strongest prognostic increment to cTn levels in ACS. However, the role of these biomarkers for clinical decision-making in contemporary settings has still to be defined.

Keywords: Acute coronary syndrome; Biomarkers; Risk prediction.

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Conflict of interest statement

Conflict of Interest

Dr. Eggers has received honoraria from Abbott Laboratories and AstraZeneca and has served as a consultant for Abbott Laboratories and Fiomi Diagnostics.

Dr. Lindahl has served as a consultant for Roche Diagnostics, Thermo Fisher Scientific, bioMérieux Clinical Diagnostics, Philips Healthcare and Fiomi Diagnostics and has received research grants from bioMérieux Clinical Diagnostics and Fiomi Diagnostics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Pathobiologic mechanisms in acute coronary syndrome and associated biomarkers. ACS acute coronary syndrome, LV left-ventricular, BNP B-type natriuretic peptide, NT-proBNP N-terminal pro B-type natriuretic peptide, CRP C-reactive protein, GDF-15 growth differentiation factor-15, eGFR estimated glomerular filtration rate
See this image and copyright information in PMC

References

    1. White HD. Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis? J Am Coll Cardiol. 2011;57:2406–8. doi: 10.1016/j.jacc.2011.01.029. - DOI - PubMed
    1. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581–98. doi: 10.1016/j.jacc.2012.08.001. - DOI - PubMed
    1. Lindahl B, Diderholm E, Lagerqvist B, Venge P, Wallentin L. FRISC II (Fast Revascularization during InStability in CAD) Investigators. Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: a FRISC II substudy. J Am Coll Cardiol. 2001;38:979–86. doi: 10.1016/S0735-1097(01)01501-7. - DOI - PubMed
    1. Hallén J. Troponin for the estimation of infarct size: what have we learned? Cardiology. 2012;121:204–12. doi: 10.1159/000337113. - DOI - PubMed
    1. Morrow DA, Cannon CP, Rifai N, Frey MJ, Vicari R, Lakkis N, et al. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001;286:2405–12. doi: 10.1001/jama.286.19.2405. - DOI - PubMed

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