Novel Cardiac Biomarkers for Emergency Department Evaluation of Acute Coronary Syndrome: The Recent Evidence on Non-troponin Biomarkers and Their Limitations

Purpose of Review Evaluation of chest pain in the emergency department remains a common diagnostic challenge. Significant concerns persist regarding the potential for missed acute coronary syndrome and the limitations of troponin as a diagnostic biomarker. Therefore, recent research has explored and shed further light on a variety of novel biomarkers for use in the evaluation of chest pain and possible acute coronary syndrome. Recent Findings This article reviews the most recent literature regarding four of the biomarkers that have generated the most interest: matrix metalloproteinases, copeptin, ischemia-modified albumin, and heart-type fatty acid binding protein. Pregnancy-associated plasma protein A is also considered. Research has studied these both independently, and in conjunction with troponin assays. This review additionally addresses the potential role of risk stratification in applying these biomarkers. Summary There remain concerns about the limitations of a troponin-based diagnostic strategy and the potential for missed myocardial infarction. However, despite the promise of a variety of novel biomarkers, the limitations of these alternatives remain apparent.