Cardiac biomarkers: past, present, and future

Accurate recognition of signs and symptoms and prompt diagnosis of myocardial infarction are essential for preserving myocardial function and saving lives. However, measurements of cardiac enzymes such as creatine kinase, lactate dehydrogenase, and their isoenzymes do not always provide accurate clinical diagnosis, particularly in patients with other concomitant diseases. Recently, alternative biomarkers of cardiac disease have been described: creatine kinase mass, cardiac troponins, and myoglobin. All cardiac biomarkers have some clinical usefulness in diagnosing acute coronary syndrome and acute myocardial infarction. Indications for use vary for each biomarker, and each has advantages and disadvantages and can be used at various times. However, the following must be considered: (1) Serial testing is essential with any biomarker. (2) None of the current biomarkers can be used to detect myocardial ischemia. (3) The decision of which biomarker to use should be based on the capabilities of the healthcare facility and the signs and symptoms of the patient.