BIOCHEMICAL MARKERS OF THE ACUTE CORONARY SYNDROMES

The acute coronary syndromes represent a continuum of myocardial ische mia ranging from angina, reversible tissue injury --> unstable angina, frequently associated with minor myocardial damage --> myocardial inf arction and extensive tissue necrosis. Historically, coronary artery d isease assessment has been mainly binary, using WHO criteria of sympto ms, electrocardiography, and biochemical markers. The creatine kinase- MB isoenzyme (CK-MB) has been a benchmark for markers, but it is not s pecific for myocardium. Cardiac-specific isoforms of troponin T and I have emerged as sensitive myocardial infarction (MI) indicators and, i mportantly, for risk stratification of acute coronary syndrome patient s. In addition to markers of myocardial cell necrosis, markers of plaq ue disruption (C-reactive protein and serum amyloid A), ''angry'' plat elets (P-selectin), ischemia (glycogen phosphorylase-BB isoenzyme), an d the procoagulant state and thrombosis (soluble fibrin) have potentia l use. Also, CK-MB and myoglobin have been combined with clinical indi cators for monitoring reperfusion after thrombolytic therapy. Biochemi cal markers will continue to be an important clinical adjunct for MI d iagnosis, risk assessment, and reperfusion monitoring in the future.