This has lead to the implementation of chest pain units where these patients with unspecific symptoms and a multitude of differential diagnoses are evaluated by expert physicians. The rapid and accurate differentiation of acute coronary syndromes (ACS) from other causes of chest discomfort is of vital importance and in many cases it remains a clinical challenge.
After evaluating a patient’s symptoms, conducting a physical examination, and performance of an ECG the clinician is often left with considerable diagnostic uncertainty, which delays the initiation of appropriate therapy. During the last years beside creatin kinase MB and myoglobin the very specific troponins have evolved as cardiac enzymes which facilitate decision-making and have been introduced into the guidelines for acute coronary syndromes. Their well-known disadvantage is the lack of harmonisation in the determination method and the duration till relevant elevation of about four hours after the onset of the ischemic event.
Given that we already have many established markers of CAD activity and future coronary heart disease risk, it will be imperative in the future to demonstrate the precise additive value of any newly discovered or proposed biomarkers over and above established practice.
Most importantly, it will be crucial to identify marker combinations that will offer a synergistic joint use. These markers should not be highly correlated and should improve diagnosis and risk prediction over and above troponin measures.