Potential clinical application of novel cardiac biomarkers for acute myocardial infarction.

Coronary heart disease is the leading cause of cardiac related death worldwide. Therefore, early and accurate diagnosis of acute coronary syndrome is required to determine the next clinical step. The current gold standard for cardiac markers, troponin and CK-MB have their downside. The delayed increase of detectable circulating level of these markers contribute to delayed diagnosis and therapy. Novel biomarkers that rise earlier, has a good diagnosis accuracy and has additional prognostic information, are highly needed. There are some potential emerging novel biomarkers for acute myocardial infarction. High sensitivity troponin have a greater sensitivity and accuracy for detection and early exclusion of myocardial infarction, as compared to troponin. B-natriuretic peptide (BNP and NT-pro BNP) provide prognostic information in regards of mortality. Myeloperoxidase identify subjects with increased risk of cardiac events in the absence of myocardial necrosis. Dual marker strategy combining copeptin with troponin T is more accurate assay to diagnose acute myocardial infarction. The level of Growth Differentiation Factor-15 is correlated with the risk of death or myocardial infarction in the next 6 months. While, Heart-Fatty Acid Binding Protein assay is an earlier marker for myocardial necrosis and provide valuable prognostic information and can further stratify patients' risk. Novel cardiac biomarkers provide a faster exclusion of acute myocardial infarction, yet with very good accuracy. However unlike their predecessors, the clinical use of these novel cardiac biomarkers are not only limited to establishing the diagnosis of myocardial infarction. Novel cardiac biomarkers possess additional potential use, some of which are to determine patients' prognosis and to further stratify patients' risk that would determine the next step of therapy.