Clinical and pathobiologic considerations in the evaluation of markers of myocardial ischemia
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There is a need for blood-based analytic techniques that allow for the detection of patients either with reversible myocardial ischemia or who are at risk for myocardial ischemia. However, given the diverse etiologies of unstable angina and the complex interactions among various cell types, the term “marker for ischemia” should be used with caution (if at all). Unless we find a protein that is released across the diverse pathologic triggers associated with the various stages of progression of atherosclerosis and cellular ischemia, we will be forced to consider a spectrum of proteins (and analytic assays) that are situationally specific. The choice of an appropriate gold standard as we investigate the clinical application of these assays will be one of the most difficult and most important decisions in these studies. It will be critical that conclusions of usefulness in one setting of ischemic heart disease not be generalized in the absence of clinical trials supporting that contention.
Key WordsIschemia biomarkers myocardial infarction
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