The future of biomarkers in the management of patients with acute coronary syndromes

Purpose of review Biomarkers play an important role in the diagnosis and management of patients with acute coronary syndromes. The rapid growth of candidate novel markers has emphasized the need for a systematic approach to their evaluation. Recent findings Several biomarkers in the past few years have been shown to be useful for risk stratification in patients with acute coronary syndromes. However, in addition to demonstrating reproducibility across large patient populations, novel markers, including high-sensitivity troponin assays, need to convincingly demonstrate their incremental utility beyond that of existing markers and should contribute toward improved patient care. Many existing biomarkers measure facets of the same disease process and are tightly correlated, thereby reducing the probability that a candidate marker will add substantial incremental discrimination for risk stratification. Unbiased approaches to identifying new markers, such as genome-wide association studies, may prove to be useful for helping in identifying genomic sequence variants, as well as protein or metabolite perturbations, which reflect novel disease-associated pathways. Summary The number of novel biomarkers is expected to continue to grow exponentially over the next few years. Candidate markers should undergo rigorous evaluation before being adopted into clinical practice.