Circulating Biomarkers in Acute Coronary Syndromes

During the past 30 years, there have been significant advances in our treatment of cardiovascular disease, both in the acute setting and in the context of disease prevention.1 With regard to the former, the availability and safety of acute medical and revascularization strategies for myocardial infarction and unstable angina have reduced both the morbidity and mortality of acute coronary syndromes (ACS).2 Acute treatment options are typically resource intensive, however, and up to 50% of patients hospitalized for suspected ACS ultimately leave the hospital with other diagnoses.3 As a consequence, current guidelines for the management of ACS2 stress risk stratification as a means for directing invasive versus conservative approaches to patient management.See p 812 The traditional clinical tools of risk stratification such as history, physical examination, and ECG have proven inadequate in the vast majority of cases. Not surprisingly, this need has spurred considerable investigation into circulating markers that better establish diagnoses and identify high-risk individuals appropriate for the most resource-intensive treatment. From this search, cardiac troponin measurements have emerged as important markers for both ACS diagnosis and identification of future coronary artery disease (CAD) events.2 More recently, circulating markers of inflammation such as C-reactive protein,4 CD40L,5 and myeloperoxidase6 have also proven effective in identifying patients with ACS.In this issue of Circulation , Hayashida and colleagues7 have added soluble lectin-like oxidized LDL receptor-1 (sLOX-1) to this expanding list of markers that are associated with ACS. They examined 427 consecutive patients undergoing cardiac catheterization from a single center and measured sLOX-1 in serum. The presence or absence of CAD was determined by angiographic criteria, …