doi: 10.1161/01.CIR.0000135581.79161.35
(Circulation. 2004;110:104-106.)
© 2004 American Heart Association, Inc.
Editorial |
Acute Coronary Syndrome Biomarkers
The Need for More Adequate Reporting
From the Mayo Clinic, Rochester, Minn (A.S.J.), and University of Heidelberg, Heidelberg, Germany (H.K.).
Correspondence to Allan S. Jaffe, MD, Mayo Clinic, Department of Laboratory Medicine & Pathology, 200 First St SW, 16th Floor, Rochester, MN 55905. E-mail jaffe.allan@mayo.edu
Key Words: Editorials • coronary disease • troponin
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Improvements in our understanding of the pathophysiology of atherosclerosis and acute coronary syndromes (ACS) have led to an "explosion" in the development of assays of blood biomarkers to characterize these processes and to predict prognosis. These research assays are performed in a single-center research setting and often use plasma specimens collected in highly selected study populations on which a multitude of biomarkers has been tested in the past. All of these novel markers seem to add prognostic information to established risk indices of ACS. How can so many different analytes all be so predictive?
One reason may be that the diagnostic tools under investigation are optimized with respect to their characteristics and discriminator limits to gain optimal predictive power in the very specific study cohort. Should these tools and their decision limits be applied to a chest pain population with different characteristics, however, specificity may become a significant problem markedly affecting accuracy. Furthermore, application of these tools in a routine setting not allowing such careful sample preparation or optimization procedures may markedly reduce sensitivity.
Another reason, and we shall concentrate on this point here, is that the presently available markers are used in a less than optimal manner. However, if the lack of optimal use of the present makers is not made explicit, it may distort both the importance of the new marker and how to use established markers. Many recent reports have, in our estimation, done this but have failed to acknowledge it overtly in the manuscript, perhaps leading
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