Mirror, mirror on the wall: the quest for the earliest marker of myocardial ischaemiaThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Abstract

This editorial refers to ‘Serum deoxyribonuclease I activity can be used as a sensitive marker for detection of transient myocardial ischaemia induced by percutaneous coronary intervention'† by K. Arakawa et al., on page 2375 In patients with acute ST-segment elevation myocardial infarction (STEMI), the diagnosis and immediate initiation of reperfusion therapy is based on the standard 12-lead ECG. Owing to the fact that cardiac markers appear in the blood a substantial time after the onset of symptoms, cardiac markers are neither helpful for early diagnosis of patients with STEMI nor should results be awaited before initiation of recanalization therapy. Unfortunately, at least 40% of all patients with confirmed acute myocardial infarction (AMI) show no diagnostic ECG changes on admission.1 In these patients with suspected acute coronary syndrome (ACS), cardiac troponins have become the biochemical gold standard for classification, risk stratification, and guidance of therapy.1 Cardiac troponins owe their exclusive superiority to their cardiospecificity, which indicates myocardial necrosis, and to their higher sensitivity compared with creatine kinase. However, obviously myocardial necrosis is a prerequisite for appearance of troponins in the blood, and the inflicting event needs to have occurred a few hours earlier.2 Novel cardiac markers ideally should improve these limitations by appearing earlier in the blood in case of an AMI, or by allowing identification of myocardial ischaemia in advance, or even in the absence … *Corresponding author. Tel: +49 6221 56 8670. E-mail address : hugo_katus{at}med.uni-heidelberg.de