Early Detection of Acute Coronary Syndromes and Risk Stratification by Multimarker Analysis

Cardiac troponin is the standard biomarker for the diagnosis of acute myocardial infarction (AMI) and risk stratification for short-term adverse cardiac events (death, AMI or need for revascularization). Unfortunately, the concentration of troponin in blood is normal in AMI patients who present early after the onset of symptoms. As such, there is active research being conducted in finding early markers of AMI and risk stratification. Despite years of testing dozens of candidates, no single test has had the necessary clinical sensitivity and specificity for this indication. Therefore, many researchers have advocated multimarker testing. There are two approaches that have been taken for discovering new markers. The proteomic approach involves focusing on the differences in the biochemical signatures between the tissues or biological fluids of normal compared with diseased individuals. Specific biochemical targets are not preselected. The pathophysiologic approach involves combining biomarkers that indicate a particular pathway or event known to be involved in the disease process. In both approaches, some bioinformatic algorithm will be necessary in order to combine the information provided by the individual tests. Representative approaches include the Multimarker Index, classification and regression tree analysis and neural networks.