What is the role of biomarkers in the workup of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Levels of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro-BNP) are elevated in acute MI and provide predictive information for risk stratification across the spectrum of ACS. [38, 39] However, a single, low BNP level obtained within 4 hours of a patient presenting to the ED does not identify the patient as low-risk for 30-day acute myocardial infarction or death. [40]

In the future, a combination of levels of troponin (a biomarker for myocardial necrosis), NT-pro-BNP (an indicator of elevated LV end-diastolic pressure and wall stress), and C-reactive protein (CRP, an estimate of the extent of systemic inflammation) may prove useful for predicting the outcome of patients with ACS.

Routine measurement of BNP and CRP levels in patients with ACS is not warranted at this time.

Interleukin-6 is the major determinant of acute-phase reactant proteins in the liver, and serum amyloid A is another acute-phase reactant. Elevations of either of these can be predictive in determining increased risk of adverse outcomes in patients with unstable angina.

Cavusoqlu et al suggests that elevated baseline levels of plasma interleukin-10 are associated with long-term adverse outcomes in patients with ACS. [41]

Several other biomarkers with variable sensitivity and specificity have been investigated, including sCD40 ligand, myeloperoxidase, pregnancy-associated plasma protein-A, choline, placental growth factor, cystatin C, fatty acid binding protein, ischemia modified albumin, chemokines ligand-5 and -18 (mediators of monocyte recruitment induced by ischemia), angiogenin, SCUBE1 (a novel platelet protein), and others. [42, 43] In a study that included 107 patients presenting to an emergency department with chest pain, ischemia modified albumin was not found to have superior sensitivity and specificity over traditional biomarkers, with a sensitivity of 0.86 and specificity of 0.49. [44]

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