Advances in Early Detection of Acute Coronary Syndrome Using High-Sensitivity Biomarkers

Abstract

Introduction: Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality, requiring rapid and accurate diagnosis to facilitate timely treatment and improve patient outcomes. Although high-sensitivity cardiac troponin (hs-cTn) is the cornerstone biomarker for ACS diagnosis, additional biomarkers may enhance early detection and risk stratification. This study aimed to evaluate the diagnostic performance of hs-cTn, copeptin, heart-type fatty acid-binding protein (H-FABP), and growth differentiation factor-15 (GDF-15), individually and in combination, for the early identification of ACS.

Methodology: A retrospective observational study was conducted involving 170 patients presenting with suspected ACS. Blood samples obtained at presentation were analyzed for hs-cTn, copeptin, H-FABP, and GDF-15 levels. ACS diagnosis was established according to the Fourth Universal Definition of Myocardial Infarction, based on clinical evidence of myocardial ischemia, electrocardiographic findings, and cardiac troponin dynamics. Final diagnoses were independently adjudicated by two cardiologists blinded to biomarker results. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Statistical analyses included Student’s t-test, chi-square test, Mann–Whitney U test, analysis of variance (ANOVA) with post hoc testing, and multivariate logistic regression analysis.

Results: Of 170 patients, 92 had ACS. All biomarkers were statistically significantly elevated in the ACS group compared with the non-ACS group (p < 0.001). The combined biomarker model demonstrated the highest diagnostic accuracy (AUC = 0.95), with a sensitivity of 92.4% and specificity of 90.2%. Multivariate logistic regression identified hs-cTn and copeptin as independent predictors of ACS.

Conclusion: The combined use of high-sensitivity biomarkers significantly improves the early diagnosis of ACS and enhances clinical risk stratification. These findings support their potential role in emergency department diagnostic pathways. Further prospective multicenter studies are warranted to validate their clinical utility and facilitate more rapid and accurate decision-making.