Clinical significance and effectiveness of various serum biomarkers in diagnosis of myocardial infarction

Abstract

Myocardial infarction (MI) causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biochemical markers play a pivotal role in the diagnosis and management of patients with acute myocardial infarction. The older biomarkers like aspartate transaminase, creatine kinase, lactate dehydrogenase has lost their utility due to lack of specificity and limited sensitivity. This paper reviews the current contribution of the biochemical marker determination to clinical cardiology and discusses some important developments in this field. Despite the success of cardiac troponins which are gold standard, there is still a need for the development of early markers that can reliably rule out acute myocardial infarction from the emergency room at presentation and also detect myocardial ischaemia in the absence of irreversible myocyte injury. Since no single biomarker fulfils the criteria of ideal biomarker, the National Academy of Clinical Biochemistry (NACB) proposes the use of two biomarkers for the diagnosis of acute myocardial infarction: early marker – myoglobin and a definitive marker – cardiac troponins. Among the new biomarkers, heart type fatty acid binding protein, glycogen phosphorylase isoenzyme BB, ischaemia modified albumin seem to be promising.