Biomarkers and Acute Coronary Syndromes
Biomarker
a distinctive biological or biologically derived indicator (as a biochemical metabolite in the body) of a process, event, or condition (as aging, disease, or exposure to a toxic substance)(ref)
Acute coronary syndrome (ACS)
The term acute coronary syndrome refers to a range of acutemyocardial ischaemic states. It encompasses unstable angina,non-ST segment elevation myocardial infarction (ST segmentelevation generally absent), and ST segment elevation infarction. The process central to the initiation of an acute coronary syndromeis disruption of an atheromatous plaque. Fissuring or ruptureof these plaques—and consequent exposure of core constituentssuch as lipid, smooth muscle, and foam cells—leads tothe local generation of thrombin and deposition of fibrin.This in turn promotes platelet aggregation and adhesion andthe formation of intracoronary thrombus. Displayed in the figure is the spectrum of acute coronary syndromes according to electrocardiographic and biochemical markers of myocardial necrosis (troponin T, troponin I, and creatine kinase MB), in patients presenting with acute cardiac chest pain (ref)
Biomarkers and vulnerable plaque
Atherosclerosis is a comlex disease, understanding the relation between serum biomarkers and the proces of vulnerable (unstable) plaque development is important to enable risk stratification and to develop new treatments. One of the studies performed at our center investigated IP-10 (CXCL10) and plaque vulnerability in human tissue and a mouse model.
Biomarkers for predicting coronary events: the BIOMArCS project
As atherosclerosis is a chronic disease, that can result in acute complications in the form of an ACS, monitoring the disease may improve treatment options. Biomarkers may provide a means to 1. stratify patients in a higher risk category for an ACS and 2. enable prediction of an ACS when measured serially. BIOMArCS is a multi-centre, prospective, observational study with 1-year follow-up of 700 patients after ACS, either with or without ST-elevation. Patients with at least two cardiovascular risk factors are included, so that the primary endpoint (cardiovascular mortality or repeat non-fatal ACS) is likely to occur in 10% of the cohort. Venapuncture is planned every fortnight during the first half-year and monthly thereafter. Biomarker patterns prior to the endpoint will be determined at the end of follow-up in the (suspected) 70 cases and compared to 210 event-free, matching controls.