Prolonged Chest Pain and the Early Detection of Myocardial Damage by Novel Biochemical Markers — Practical Considerations

Abstract

In recent years rapid analytical techniques have been developed which allow accurate measurement of biochemical serum markers useful for the detection of early myocardial damage and acute myocardial infarction (AMI). Early diagnosis of AMI is likely to improve patient management and reduce complications. The availability of sensitive biochemical markers may result in the identification of low-risk patients and allow for early triage and rational use of Coronary Care Unit (CCU) beds. The potential clinical implications of rapid and accurate new assays are obvious and have triggered great interest. This is reflected by the large number of reports on the early diagnostic value of biochemical markers such as myoglobin [1–3], CK-MB mass [4,5],CK-isoforms [6], troponin T (TnT) [7–9], troponin I (TnI) [10,11] and fatty acid binding protein (FABP) [12]. At least partially, this interest may be “industry-driven” and for practically every biochemical marker, assays are currently available from different manufacturers. The interest is also driven by health economics and managed-care programs. For example in the United States health maintenance organizations (HMOs) may refuse the reimbursement of costs for patients “wrongly” admitted to CCU [13]. Growing interest in the novel biochemical markers is also driven by the obvious implications of the early and accurate diagnosis of myocardial damage. However, the advent of a large number of these markers has raised a series of practical issues. With the large choice of novel markers available, it is difficult for the treating physician to decide what marker(s) to use or even what strategy is appropriate for risk stratification and management of acute chest pain patients. The focus of this chapter will be on the role of biochemical markers in the detection or exclusion of myocardial damage in chest pain patients and the possible implications for triage and patient management in the first 24 hours from the onset of chest pain.KeywordsAcute Myocardial InfarctionAcute Myocardial InfarctionMyocardial DamageCardiac TroponinCoronary Care UnitThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.