Current and Prospective Biochemical Markers for the Identification of Acute Coronary Syndrome-A Review
Authors: Nadendla Rama Rao , Narayanan Harish , Murgod Roopa , Alboloi Khalid Suliman , Savira Maya , Muthuprasanna Pichandy 
Published: January 2025

Acute coronary syndrome (ACS) represents a spectrum of heart muscle oxygen deprivation (ischemia) which ranges from temporary tissue damage in angina to unstable angina with possible minor cell death and finally to a full-blown heart attack (myocardial infarction) with extensive tissue necrosis. Biochemical indicators of damage to the heart muscle remain crucial in the comprehensive evaluation and management of individuals with various forms of ACS. Diagnosing ACS accurately is crucial for optimal treatment. While existing biochemical markers play a vital role, searching for an ideal biomarker continues. Biochemical markers of myocardial injury are critical for the global assessment and treatment of individuals with these syndromes. The objective of the review, is to primarily evaluate the current understanding of ACS biomarkers rather than specifically to assess which biomarkers are most promising. The review emphasizes the importance of existing biochemical markers, the ongoing search for an ideal biomarker, and how these markers are crucial for the diagnosis and management of ACS. This review examines various biochemical markers associated with atherosclerosis, including matrixins, PAPP-A metalloproteinase, myeloperoxidase, microalbuminuria, cystatin, P-selectin, glycogen phosphorylase-BB, C-reactive protein marker, cluster of differentiation 40 (CD40L) marker, creatine kinase-myocardial band (CK-MB), and ischemia-modified albumin. Traditional biomarker Tn levels may not rise immediately during ischemia, but MPO levels increase earlier, aiding early ACS detection. MPO, produced during inflammation, offers predictive data surpassing troponins. IMA also rises faster than troponins, signaling myocardial ischemia before irreversible damage. hs-CRP provides insights into inflammation and cardiovascular risk, complementing troponins. MicroRNAs serve as precise biomarkers for ACS, surpassing troponins in detecting molecular changes linked to the disease. These biomarkers enhance early diagnosis and treatment. Clinically, Tn levels may not have significantly risen at the early stage of ischemia; however, other biomarkers should be considered for early detection and risk stratification. Elevated MPO and IMA levels can indicate myocardial ischemia and inflammation earlier than troponins. hs-CRP offers additional insights into systemic inflammation and cardiovascular risk. MicroRNAs provide detailed molecular data and may outperform troponins in identifying ACS, offering a more sensitive diagnostic approach. Further monitoring and treatment adjustments based on these biomarkers are advised. In conclusion, while troponins remain crucial in diagnosing ACS, novel biomarkers like MPO, IMA, hs-CRP, and microRNAs offer earlier detection and better risk assessment. These markers provide additional insights into ischemia and inflammation, improving diagnostic accuracy and patient outcomes when used alongside traditional biomarkers.