Biomarkers in acute myocardial infarction: current perspectives

Vascular Health and Risk Management Dovepress open access to scientific and medical research REVIEW Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 86.8.250.196 on 24-Jun-2020 For personal use only. Open Access Full Text Article Biomarkers in acute myocardial infarction: current perspectives This article was published in the following Dove Medical Press journal: Vascular Health and Risk Management Suleyman Aydin 1 Kader Ugur 2 Suna Aydin 3 İbrahim Sahin 1,4 Meltem Yardim 1 1 Department of Medical Biochemistry and Clinical Biochemistry (Firat Hormones Research Group), Medical School, Firat University, Elazig 23119, Turkey; 2Department of Internal Medicine (Endocrinology and Metabolism Diseases), School of Medicine, Firat University, Elazig 23119, Turkey; 3Cardiovascular Surgery Department, Elazig Research and Education Hospital, Health Science University, Elazig 23119, Turkey; 4Department of Medical Biology, Medical School, Erzincan Binali Yildirim University, Erzincan 24100, Turkey Introduction Correspondence: Suleyman Aydin Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Hospital Street, Elazig 23119, Turkey Tel +90 533 493 4643 Fax +90 424 237 9138 Email Acute myocardial infarction (AMI) is one of the major causes of mortality and morbidity worldwide.1 About 10% of patients who are admitted to emergency departments with chest pain every year are diagnosed with heart attack.2 AMI is a condition that can be due to ischemic heart disease or coronary artery disease in conjunction, and it becomes manifest when an atherosclerotic plate ruptures and a developing thrombus occludes the coronary artery totally or partially, restricting blood access to the heart (Figure 1).3,4 In this case, the opening of the occluded coronary artery is usually provided by inserting a stent. However, when stents are insufficient, coronary bypass is performed by cardiac pulmonary bypass surgery using the left internal mammary artery or saphenous vein to maintain regular nourishment of the heart.5 AMI has found its place in the concept of acute coronary syndrome (ACS). ACS includes a group of clinical syndromes ranging from unstable angina pectoris, AMI with non-S (downward deflection immediately after ventricular contraction)-segment elevation, and T (recovery of ventricles)-segment elevation to AMI, with ST-segment 1 submit your manuscript | www.dovepress.com Vascular Health and Risk Management 2019:15 1–10 Dovepress © 2019 Aydin et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/VHRM.S166157 Powered by TCPDF (www.tcpdf.org) Purpose: Acute myocardial infarction (AMI) is the most common cause of death in the world. Comprehensive risk assessment of patients presenting with chest pain and eliminating undesirable results should decrease morbidity and mortality rates, increase the quality of life of patients, and decrease health expenditure in many countries. In this study, the advantages and disadvantages of the enzymatic and nonenzymatic biomarkers used in the diagnosis of patients with AMI are given in historical sequence, and some candidate biomarkers – hFABP, GPBB, S100, PAPPA, RP, TNF, IL6, IL18, CD40 ligand, MPO, MMP9, cell-adhesion molecules, oxidized LDL, glutathione, homocysteine, fibrinogen, and D-dimer procalcitonin – with a possible role in the diagnosis of AMI are discussed. Methods: The present study was carried out using meta-analyses, reviews of clinical trials, evidence-based medicine, and guidelines indexed in PubMed and Web of Science. Results: These numerous AMI biomarkers guide clinical applications (diagnostic methods, risk stratification, and treatment). Today, however, TnI remains the gold standard for the diagnosis of AMI. Details in the text will be given of many biomarkers for the diagnosis of AMI. Conclusion: We evaluated the advantages and disadvantages of routine enzymatic and nonenzymatic biomarkers and the literature evidence of other candidate biomarkers in the diagnosis of AMI, and discuss challenges and constraints that limit translational use from bench to bedside. Keywords: acute myocardial infarction, cardiac protein, cardiac peptide Dovepress Aydin et al Left coronary artery Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 86.8.250.196 on 24-Jun-2020 For personal use only. Circumflex branch of left coronary artery Right coronary artery Anterior interventricular branch of left coronary artery Right marginal branch of right coronary artery Figure 1 Gross anatomy of heart. elevation and sudden death.6 The sensitivity and specificity of electrocardiography (ECG) are low in ACS.7 In the majority of cases with ST-segment elevation in ECG and typical ischemic chest pain, AMI with a Q wave (downward deflection immediately preceding ventricular contraction) develops in most cases and AMI without a Q wave develops in a few. However, the majority of cases without ST-segment elevation develop unstable angina pectoris or AMI without a Q wave, with a few developing AMI with a Q wave. STsegment elevation changes into ST-segment depression when an oxygen-free environment persists.8 As the sensitivity and specificity of ECG are low in diagnosing AMI, the criteria for AMI were decided by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC).9,10 Accordingly, a patient has to have at least two of the following: typical symptoms, a characteristic elevation or decrease pattern in cardiac markers (eg, CK-MB izoenzymes), preferably serum troponins (cTnI or cTnT), or a typical ECG trace with Q waves that indicate a diagnosis of AMI.4,11 Ischemia due to decreased coronary artery flow causes deterioration of ventricular function and myocardial necrosis.12 Therefore, such enzymes as ALT, AST, LDH, CK, and troponins have been indicators for years us a diagnosis of 2 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress AMI.13,14 Therefore, in our study, cardiac markers (cTnI and cTnT), CK-MB, and myoglobin, frequently used in diagnosing AMI and determining prognosis, are mentioned in review, and our intention is to discuss some other important candidate biomarkers, such as copeptin15 and irisin,16 which may be relevant in diagnosing AMI and determining prognosis (Figure (...truncated)