Cardiac Biomarkers in Acute Myocardial Infarction

Acute myocardial infarction (MI) is defined by the presence of myocardial necrosis in the clinical setting of acute myocardial ischemia as supported by history, physical exam, electrocardiograpic (ECG) findings and biochemical markers of myocardial necrosis. Given the wide array of biomarkers available with varying degrees of sensitivity and specificity, this chapter aims to provide an overview of the role of contemporary and emerging biomarkers in patients with acute coronary syndrome (ACS) and acute myocardial infarction (AMI). We focus particularly on patients with non-ST myocardial infarction (NSTEMI), given this syndrome will depend to a larger extent on risk stratification and diagnostic assays to dictate in-hospital treatment. This chapter will first review the third universal definition of MI then summarize the recommendations of various societies on the utilization of cardiac biomarkers in the diagnosis and management of AMI. We aim to compare and contrast these recommendations and provide commentary on the issues and controversies arising from differences between them.