The Multimarker Approach in Acute Coronary Syndrome: Integrating Markers of Myocardial Injury, Ischemia, Inflammation and Cardiac Dysfunction
Sangita M. Patil *
Department of Biochemistry, Dr. Balasaheb Vikhe Patil Public University, DVVPF’s Medical College, Ahilyanagar, Maharashtra, India.
Pradnya Padalkar
Department of Biochemistry, School of Medicine, Ambi Pune, Maharashtra, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Acute coronary syndrome (ACS) involves myocardial ischaemia, injury, inflammatory activation, and ventricular dysfunction; no single biomarker fully reflects these processes.
Objective: This narrative review examines how combining biomarkers from distinct pathophysiological domains may support diagnosis and risk stratification without displacing validated cardiac troponin pathways.
Methods: A structured narrative synthesis was undertaken using publications identified in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, principally spanning January 2015 to September 2026, with earlier landmark papers also considered. Evidence was organised into four domains: myocardial injury, ischaemia or early cellular stress, inflammation, and cardiac dysfunction.
Findings: High-sensitivity cardiac troponin I and T remain the preferred biomarkers for detecting myocardial injury and informing the diagnosis of acute myocardial infarction in conjunction with clinical evidence of ischaemia. Ischaemia-modified albumin, heart-type fatty acid-binding protein, copeptin, and related biomarkers have been investigated as adjuncts, but their incremental diagnostic performance is variable. High-sensitivity C-reactive protein and other inflammatory markers may provide information about inflammatory burden and prognosis. B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide reflect myocardial wall stress and may contribute to assessment of subsequent heart failure and mortality risk.
Conclusions: Multimarker assessment may provide complementary prognostic information, particularly when integrated with clinical examination, electrocardiography, imaging, and established risk scores. Its broader adoption requires standardised assays, clinically useful thresholds, prospective validation, and evidence that additional testing improves decision-making and outcomes.
Keywords: Acute coronary syndrome, cardiac biomarkers, high-sensitivity cardiac troponin, myocardial injury, ischemia, inflammation, cardiac dysfunction, multimarker approach