An overview and ranking of biochemical markers of cardiac disease. Strengths and limitations.

Comparing the performance of one biochemical marker of myocardial damage with another is bedeviled with many problems, including a lack of uniform calibration between instruments providing measurements of the same analyte and differing reference ranges and decision thresholds. Diagnostic groupings and various gold standards create difficulties in comparing analytic results. There is a lack of uniformity in test assessments and their use for diagnostic and prognostic purposes. Finally, there is an almost complete absence of data from economic and decision analyses of test usage. It is argued that a much more stringent and rigorous approach to these aspects is essential. The use of biochemical markers of cardiac damage is in a dynamic state, with new applications continually appearing and new markers being developed. It is therefore essential that a uniform and rigorous outlook be maintained to ensure both optimal and economic test utilization based on the previously outlined principles.