Developing a Marker of Ischemia

Clinical and Research Challenges
  • Robert L. Jesse
Part of the Contemporary Cardiology book series (CONCARD)


Assessment of the patient with suspected acute coronary syndrome (ACS) has remained challenging despite the growing armamentarium of both diagnostic and prognostic tests. Inadvertent discharge of patients thought to be at low risk of ischemia but later found to have an ACS remains unacceptably high. Present tools (history, clinical examination, electrocardiogram, and biomarkers of necrosis) are not optimally sensitive for the identification of patients with unstable angina. Technetium-based myocardial perfusion imaging is sensitive and specific and provides proof of principle that myocardial ischemia is both detectable and actionable. However, this technology is expensive and requires significant technical expertise. Biochemical tests have historically proven to be fast, accurate, simple to perform, relatively easy to interpret, and inexpensive. All of these characteristics provide a strong argument toward development of biochemical markers of myocardial ischemia. Nevertheless, there are many challenges to this effort. The physiology is complex, and it is complicated by the issues of chronicity, timing, and severity. The absence of a “gold standard” for diagnosis of unstable angina makes comparative analyses difficult to interpret. However, if successful, the potential payback is tremendous in terms of improved clinical management and outcomes.

Key Words

Unstable angina ischemia biomarkers diagnosis 


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Copyright information

© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Robert L. Jesse
    • 1
    • 2
  1. 1.Acute Cardiac Care, Coronary ICUVirginia Commonwealth University Health SystemRichmond
  2. 2.Cardiology SectionDepartment of Veterans Affairs Medical CenterRichmond

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