Razzouk Louai, Fusaro Mario, Esquitin Ricardo
Division of Cardiology, Department of Medicine- NYU Langone Medical Center, NY, USA.
Curr Cardiol Rev. 2012 May;8(2):109-15. doi: 10.2174/157340312801784943.
Chest pain and other symptoms that may represent acute coronary syndromes (ACS) are common reasons for emergency department (ED) presentations, accounting for over six million visits annually in the United States [1]. Chest pain is the second most common ED presentation in the United States. Delays in diagnosis and inaccurate risk stratification of chest pain can result in serious morbidity and mortality from ACS, pulmonary embolism (PE), aortic dissection and other serious pathology. Because of the high morbidity, mortality, and liability issues associated with both recognized and unrecognized cardiovascular pathology, an aggressive approach to the evaluation of this patient group has become the standard of care. Clinical history, physical examination and electrocardiography have a limited diagnostic and prognostic role in the evaluation of possible ACS, PE, and aortic dissection, so clinicians continue to seek more accurate means of risk stratification. Recent advances in diagnostic imaging techniques particularly computed-tomography of the coronary arteries and aorta, have significantly improved our ability to diagnose life-threatening cardiovascular disease. In an era where health care utilization and cost are major considerations in how disease is managed, it is crucial to risk-stratify patients quickly and efficiently. Historically, biomarkers have played a significant role in the diagnosis and risk stratification of several cardiovascular disease states including myocardial infarction, congestive heart failure, and pulmonary embolus. Multiple biomarkers have shown early promise in answering questions of risk stratification and early diagnosis of cardiovascular pathology however many do not yet have wide clinical availability. The goal of this review will be to discuss these novel biomarkers and describe their potential role in direct patient care.
胸痛及其他可能提示急性冠状动脉综合征（ACS）的症状是急诊科就诊的常见原因，在美国每年有超过600万次就诊[1]。胸痛是美国急诊科第二常见的就诊原因。胸痛诊断的延迟和风险分层的不准确可导致ACS、肺栓塞（PE）、主动脉夹层及其他严重病变引起严重的发病率和死亡率。由于已识别和未识别的心血管病变均与高发病率、死亡率及责任问题相关，对该患者群体采取积极的评估方法已成为治疗标准。临床病史、体格检查和心电图在评估可能的ACS、PE和主动脉夹层时，诊断和预后作用有限，因此临床医生继续寻求更准确的风险分层方法。诊断成像技术的最新进展，尤其是冠状动脉和主动脉的计算机断层扫描，显著提高了我们诊断危及生命的心血管疾病的能力。在一个医疗保健利用和成本是疾病管理主要考虑因素的时代，快速有效地对患者进行风险分层至关重要。从历史上看，生物标志物在包括心肌梗死、充血性心力衰竭和肺栓塞在内的几种心血管疾病状态的诊断和风险分层中发挥了重要作用。多种生物标志物在回答心血管病变的风险分层和早期诊断问题方面已初现成效，然而许多生物标志物尚未广泛应用于临床。本综述的目的是讨论这些新型生物标志物，并描述它们在直接患者护理中的潜在作用。
