Each year, a large number of patients are seen in the Emergency Department with presentations necessitating investigation for possible acute
myocardial infarction. Patients can be stratified by symptoms, risk factors and electrocardiogram results but cardiac
biomarkers also have a prime role both diagnostically and prognostically. This review summarizes both the history of cardiac
biomarkers as well as currently available (established and novel) assays. Cardiac
troponin, our current "gold standard"
biomarker criterion for the diagnosis of
myocardial infarction has high sensitivity and specificity for this diagnosis and
therapies instituted in patients with elevated
troponin have been shown to influence outcomes. Other markers of myocardial
necrosis,
inflammation and neurohormonal activity have also been shown to have either diagnostic or prognostic utility, but none have been shown to be superior to
troponin. The measurement of multiple
biomarkers and the use of point of care markers may accelerate current diagnostic protocols for the assessment of such patients.