The initial evaluation of chest pain in the emergency department is based on the patients clinical history, changes in the ECG and necrosis biomarkers. Although management of patients with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction with positive markers of myocardial damage is well defined, exclusion of coronary artery disease or myocardial ischemia in the remaining patients is more challenging. This group represents the majority of patients admitted for chest pain syndromes and that have a substantial risk of an adverse outcome. Given that troponin, as a marker of myocardial damage, detects terminal events in the cascade of acute coronary syndrome, there is a need to search for biomarkers that are able to identify patients at high risk, allowing rapid, bedside stratification. Data suggest that clinical events are prone to occur more frequently in patients with coronary artery stenosis associated with myocardial ischemia. Accordingly, identification of systemic biomarkers of ischemia could facilitate identification of high-risk patients with a high burden of coronary atherosclerosis and plaque rupture. We describe six biomarkers that have been linked to myocardial ischemia. Until now, these biomarkers of ischemia are relevant in order to exclude ischemic heart disease (high negative predictive value) but still lack specificity. Future prospective studies should be performed in larger and more diverse sets of patients presenting with ischemia, and in a complementary fashion in order to provide valuable tools for clinical decision making. © 2010 Future Medicine Ltd.

Biomarkers of vulnerable plaque: The missing link with ischemia / Muller, Olivier; Barbato, Emanuele; De Bruyne, Bernard; Bartunek, Jozef. - In: BIOMARKERS IN MEDICINE. - ISSN 1752-0363. - 4:3(2010), pp. 375-383. [10.2217/bmm.10.59]

Biomarkers of vulnerable plaque: The missing link with ischemia

BARBATO, EMANUELE;
2010

Abstract

The initial evaluation of chest pain in the emergency department is based on the patients clinical history, changes in the ECG and necrosis biomarkers. Although management of patients with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction with positive markers of myocardial damage is well defined, exclusion of coronary artery disease or myocardial ischemia in the remaining patients is more challenging. This group represents the majority of patients admitted for chest pain syndromes and that have a substantial risk of an adverse outcome. Given that troponin, as a marker of myocardial damage, detects terminal events in the cascade of acute coronary syndrome, there is a need to search for biomarkers that are able to identify patients at high risk, allowing rapid, bedside stratification. Data suggest that clinical events are prone to occur more frequently in patients with coronary artery stenosis associated with myocardial ischemia. Accordingly, identification of systemic biomarkers of ischemia could facilitate identification of high-risk patients with a high burden of coronary atherosclerosis and plaque rupture. We describe six biomarkers that have been linked to myocardial ischemia. Until now, these biomarkers of ischemia are relevant in order to exclude ischemic heart disease (high negative predictive value) but still lack specificity. Future prospective studies should be performed in larger and more diverse sets of patients presenting with ischemia, and in a complementary fashion in order to provide valuable tools for clinical decision making. © 2010 Future Medicine Ltd.
2010
amino terminal pro brain natriuretic peptide; biological marker; brain natriuretic peptide; C reactive protein; CD40 ligand; choline; creatine kinase; creatine kinase MB; cystatin C; fatty acid; glutathione peroxidase; intercellular adhesion molecule 1; ischemia modified albumin; matrix metalloproteinase; monocyte chemotactic protein; myeloperoxidase; myoglobin; oxidized low density lipoprotein; phospholipase A; pregnancy associated protein; serum amyloid A; toll like receptor; troponin; vascular cell adhesion molecule 1; acute coronary syndrome; anamnesis; angina pectoris; atherosclerotic plaque; clinical decision making; coronary artery atherosclerosis; coronary artery disease; coronary artery obstruction; differential diagnosis; electrocardiography; emergency ward; heart muscle ischemia; heart muscle necrosis; high risk patient; hospital admission; human; medical assessment; medical research; non ST segment elevation myocardial infarction; predictive value; review; sensitivity and specificity; ST segment elevation myocardial infarction; Albumins; Biological Markers; Choline; Coronary Artery Disease; Cystatin C; Fatty Acids; Nonesterified; Humans; Myocardial Infarction; Myocardial Ischemia; Natriuretic Peptide; Brain; Toll-Like Receptors; Troponin; Biomarker; Coronary artery disease; Ischemia; Vulnerable plaque
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Biomarkers of vulnerable plaque: The missing link with ischemia / Muller, Olivier; Barbato, Emanuele; De Bruyne, Bernard; Bartunek, Jozef. - In: BIOMARKERS IN MEDICINE. - ISSN 1752-0363. - 4:3(2010), pp. 375-383. [10.2217/bmm.10.59]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1660348
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