ABSTRACT
Acute coronary syndromes (ACS) refer to a spectrum of clinical presentations ranging from ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. The main cause of ACS is the blocking of a coronary artery, which can be due to the formation of an atherosclerotic plaque or coronary spasm. The major trigger for coronary thrombosis is considered the disruption of the vulnerable atherosclerotic plaque which results in the release of various metalloproteinases (Toutouzas et al. 2012c) from activated inflammatory cells, followed by platelet activation and aggregation. Patients presenting with chest pain should undergo a full workup including physical history, an electrocardiogram (ECG) and biomarkers evaluation, while further investigations should be undertaken if warranted. The standard 12-lead ECG is the single best test to identify patients with acute myocardial infarction (AMI) (Lee et al. 1985); nonetheless, it has low sensitivity for detection of an AMI. The sensitivity for detecting a STEMI is 35-50%, leaving at least half of all AMI patients unidentifi ed (Lee et al. 1985; Selker et al. 1997). Thus, there is a great need for additional strategies and diagnostic modalities that will assist in the prompt detection of an AMI. Newer imaging modalities such as optical
1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece. *Corresponding author: ktoutouz@gmail.com
coherence tomography (OCT) (Toutouzas et al. 2012b; Toutouzas et al. 2011b) and microwave radiometry (MR) (Toutouzas et al. 2012a; Toutouzas et al. 2011a) are under investigation for probable use in identifying vulnerable plaques or other causes of ACS. Cardiac biomarkers are one of the most commonly used investigations to identify patients with a likely ACS and, ideally, a cardiac biomarker should allow early detection of ACS patients that would enable optimal treatment initiation.
