Cardiac Biomarkers in Acute Coronary Syndrome

Acute coronary syndrome encompasses a spectrum of conditions caused by sudden reduction of blood flow to the heart, with myocardial infarction and unstable angina at its core. Cardiac biomarkers—molecules released into the circulation following myocyte injury—are indispensable for rapid diagnosis, risk stratification and treatment decisions. The evolution from conventional to high-sensitivity assays has enabled detection of minute troponin elevations within hours of symptom onset, improving diagnostic accuracy. Contemporary strategies increasingly integrate quantitative troponin measurements with clinical variables and decision thresholds to expedite rule-in and rule-out pathways. Emerging point-of-care platforms and machine learning approaches promise to further personalise assessment by accounting for patient characteristics such as age, sex and comorbidities. Together, these advances underscore the global significance of biomarker‐guided pathways in reducing time to diagnosis, avoiding unnecessary admissions and optimising resource use in diverse healthcare settings.

Research from Nature Portfolio

Recent studies have harnessed machine learning to refine the interpretation of high-sensitivity troponin concentrations. One investigation developed and validated an algorithm that integrates serial troponin measurements with demographic and clinical features to generate an individualised probability score for myocardial infarction, achieving excellent discrimination and enabling safe early discharge of low-risk patients. In parallel, advances in biosensor technology have produced an ultra-fast lateral‐flow assay membrane with a barbed-arrow structure that accelerates sample flow and enhances sensitivity for troponin I. This novel membrane achieves detection limits in the low nanogram per millilitre range within minutes and demonstrates high specificity in clinical samples, offering promise for rapid bedside screening.

Cardiac Biomarkers in Acute Coronary Syndrome publication trend

The graph below shows the total number of articles in cardiac biomarkers in acute coronary syndrome across all publications each year (not limited to Nature Index journals).

Technical terms

Acute coronary syndrome (ACS): Clinical spectrum of myocardial ischaemia including unstable angina and myocardial infarction.

Cardiac troponin I (cTnI): Heart-specific protein released during cardiomyocyte injury, measured by immunoassay.

High-sensitivity assay (hs-cTn): Analytical method capable of detecting troponin at very low concentrations for early diagnosis.

Lateral-flow assay (LFA): Paper-based point-of-care test facilitating rapid biomarker detection without laboratory infrastructure.

Machine learning algorithm: Computational model trained on clinical and biomarker data to predict individual probability of myocardial infarction.

References

1. Machine learning for diagnosis of myocardial infarction using cardiac troponin concentrations. Nature Medicine (2023).
2. Barbed arrow-like structure membrane with ultra-high rectification coefficient enables ultra-fast, highly-sensitive lateral-flow assay of cTnI. Nature Communications (2024).
3. Sex Differences in Cardiac Troponin Trajectories Over the Life Course. Circulation (2023).
4. Diagnostic accuracy of a machine learning algorithm using point-of-care high-sensitivity cardiac troponin I for rapid rule-out of myocardial infarction: a retrospective study. The Lancet Digital Health (2024).