Leicester National Institute for Health Research Cardiovascular Biomedical Research Unit, UK.
BMC Med. 2010 Jun 7;8:34. doi: 10.1186/1741-7015-8-34.
Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. This may facilitate tailoring of appropriate therapy to high-risk patients. This review focuses on a variety of promising biomarkers which provide diagnostic and prognostic information. Heart-type Fatty Acid Binding Protein and copeptin in combination with cardiac troponin help diagnose myocardial infarction or acute coronary syndrome in the early hours following symptoms. An elevated N-Terminal Pro-B-type Natriuretic Peptide has been well validated to predict death and heart failure following a myocardial infarction. Similarly other biomarkers such as Mid-regional pro-Atrial Natriuretic Peptide, ST2, C-Terminal pro-endothelin 1, Mid-regional pro-Adrenomedullin and copeptin all provide incremental information in predicting death and heart failure. Growth differentiation factor-15 and high-sensitivity C-reactive protein predict death following an acute coronary syndrome. Pregnancy associated plasma protein A levels following chest pain predicts risk of myocardial infarction and revascularisation. Some biomarkers such as myeloperoxidase and high-sensitivity C-reactive protein in an apparently healthy population predicts risk of coronary disease and allows clinicians to initiate early preventative treatment. In addition to biomarkers, various well-validated scoring systems based on clinical characteristics are available to help clinicians predict mortality risk, such as the Thrombolysis In Myocardial Infarction score and Global Registry of Acute Coronary Events score. A multimarker approach incorporating biomarkers and clinical scores will increase the prognostic accuracy. However, it is important to note that only troponin has been used to direct therapeutic intervention and none of the new prognostic biomarkers have been tested and proven to alter outcome of therapeutic intervention. Novel biomarkers have improved prediction of outcome in acute myocardial infarction, but none have been demonstrated to alter the outcome of a particular therapy or management strategy. Randomised trials are urgently needed to address this translational gap before the use of novel biomarkers becomes common practice to facilitate tailored treatment following an acute coronary event.
心肌梗死可导致较高的病死率和发病率。及时诊断有助于临床医生对患者进行风险分层并选择合适的治疗方法。生物标志物已被用于辅助及时诊断，而越来越多的新型标志物被确定可用于预测急性心肌梗死或急性冠脉综合征的预后。这可能有助于为高危患者制定合适的治疗方案。本文重点介绍了多种有前景的生物标志物，这些标志物可提供诊断和预后信息。心脏型脂肪酸结合蛋白和 copeptin 与心肌肌钙蛋白联合使用有助于在症状出现后数小时内诊断心肌梗死或急性冠脉综合征。升高的 N 端脑利钠肽前体已被充分验证可用于预测心肌梗死后的死亡和心力衰竭。同样，其他生物标志物，如中段 pro-ANP、ST2、C 端内皮素 1、中段 pro-肾上腺髓质素和 copeptin，在预测死亡和心力衰竭方面均提供了额外的信息。生长分化因子 15 和高敏 C 反应蛋白可预测急性冠脉综合征后的死亡。胸痛后妊娠相关血浆蛋白 A 水平可预测心肌梗死和血运重建的风险。某些生物标志物，如髓过氧化物酶和健康人群中的高敏 C 反应蛋白，可预测冠心病风险，并使临床医生能够早期开始预防性治疗。除了生物标志物外，还有多种基于临床特征的经过充分验证的评分系统可帮助临床医生预测死亡率风险，如溶栓治疗心肌梗死评分和全球急性冠脉事件注册评分。结合生物标志物和临床评分的多标志物方法可提高预后准确性。但是，需要注意的是，只有肌钙蛋白被用于指导治疗干预，而新型预后生物标志物均未经过测试并证明可改变治疗干预的结果。新型生物标志物改善了急性心肌梗死的预后预测，但均未证明可改变特定治疗或管理策略的结果。在新型生物标志物的应用成为常规实践以促进急性冠脉事件后的个体化治疗之前，迫切需要开展随机试验来解决这一转化差距。
