Chest pain and other symptoms that may represent acute coronary syndromes (ACS) are common reasons for
emergency department (ED) presentations, accounting for over six million visits annually in the United States . Chest
pain is the second most common ED presentation in the United States. Delays in diagnosis and inaccurate risk stratification
of chest pain can result in serious morbidity and mortality from ACS, pulmonary embolism (PE), aortic dissection
and other serious pathology.
Because of the high morbidity, mortality, and liability issues associated with both recognized and unrecognized cardiovascular
pathology, an aggressive approach to the evaluation of this patient group has become the standard of care. Clinical
history, physical examination and electrocardiography have a limited diagnostic and prognostic role in the evaluation
of possible ACS, PE, and aortic dissection, so clinicians continue to seek more accurate means of risk stratification. Recent
advances in diagnostic imaging techniques particularly computed-tomography of the coronary arteries and aorta,
have significantly improved our ability to diagnose life-threatening cardiovascular disease.
In an era where health care utilization and cost are major considerations in how disease is managed, it is crucial to riskstratify
patients quickly and efficiently. Historically, biomarkers have played a significant role in the diagnosis and risk
stratification of several cardiovascular disease states including myocardial infarction, congestive heart failure, and pulmonary
embolus. Multiple biomarkers have shown early promise in answering questions of risk stratification and early diagnosis
of cardiovascular pathology however many do not yet have wide clinical availability. The goal of this review will be
to discuss these novel biomarkers and describe their potential role in direct patient care.