High-risk acute coronary syndrome patients and cardiac biomarkers in the emergency department: any role for new biomarkers of myocardial ischaemia?

Abstract

In a recent editorial, Bagwe et al. 1 discussed the role of cardiac biomarkers regarding treatment and outcomes of patients with evolving myocardial infarction (MI) in the context of the SYNERGY trial.2 High-risk acute coronary syndrome (ACS) patients with elevated cardiac troponin (cTnT) benefit from early invasive therapy, glycoprotein IIb/IIIa inhibitors, combined anti-platelet agent treatment, and the use of low molecular-weight heparins. However, while cTnT measurement has represented a useful tool for the management of acute chest pain in both the emergency department (ED) and the coronary care unit, it is known that a sizeable proportion of patients present with negative cTnT levels. Moreover, patients with unstable angina, i.e. acute chest pain, myocardial ischaemia, and negative TnT measurements, have been shown to have a high incidence (6–8%) of MI at 30 days, even …