Emerging Biomarkers in Acute Coronary Syndrome

Abstract

Acute coronary syndrome (ACS) remains one of the leading causes of morbidity and mortality worldwide despite significant advances in cardiovascular diagnosis and treatment. Early recognition of myocardial ischemia and rapid risk stratification are essential for improving clinical outcomes. Cardiac troponins remain the gold standard biomarkers for diagnosing myocardial injury; however, they have limitations in detecting very early ischemia and predicting long-term prognosis. Recent research has identified several novel biomarkers reflecting myocardial injury, inflammation, plaque instability, thrombosis, endothelial dysfunction, oxidative stress, and cardiac remodeling. Biomarkers such as copeptin, heart-type fatty acid-binding protein (H-FABP), growth differentiation factor-15 (GDF-15), soluble suppression of tumorigenicity-2 (sST2), galectin-3, microRNAs, and circulating extracellular vesicles have shown promising diagnostic and prognostic value. Contemporary strategies increasingly combine multiple biomarkers with clinical assessment, electrocardiography, and cardiac imaging to improve early diagnosis and personalized management. This review summarizes current evidence regarding established and emerging biomarkers in acute coronary syndrome and discusses their potential clinical applications.