Acute coronary syndrome
early diagnosis and prognostic impact
Keywords:
Acute coronary syndrome, Biomarkers, Cardiac troponin, Early diagnosis, PrognosisAbstract
Acute coronary syndrome remains one of the leading causes of cardiovascular morbidity and mortality and
requires early diagnosis, accurate risk stratification, and rapid therapeutic decision-making in emergency
settings. This study aimed to analyze the available evidence on early diagnostic strategies and their prognostic
implications in patients with suspected or confirmed acute coronary syndrome. This is an integrative literature
review conducted in the PubMed/MEDLINE database, including five studies published between 2016 and 2026.
The findings show that high-sensitivity cardiac troponin has expanded the ability to identify myocardial infarction
and different categories of myocardial injury, although this diagnostic improvement has not consistently
translated into better clinical outcomes. The HEART score showed superior performance compared with TIMI
and GRACE in identifying low-risk patients, supporting safer hospital discharge strategies. Coronary computed
tomography angiography demonstrated operational value by reducing unnecessary invasive procedures but
without a proven impact on mortality or nonfatal myocardial infarction. It is concluded that prognosis in acute
coronary syndrome depends not only on diagnostic accuracy, but also on the integration of biomarkers, clinical
risk scores, imaging methods, and therapeutic protocols directed at the newly identified high-risk patient groups.
References
O’Rielly CM, Harrison TG, Andruchow JE, Ronksley PE, Sajobi T, Robertson HL, Lorenzetti D, McRae AD. Risk scores for clinical risk stratification of emergency department patients with chest pain but no acute myocardial infarction: a systematic review. Can J Cardiol. 2023;39(3):304-310. doi: 10.1016/j.cjca.2022.12.028.
Poldervaart JM, Langedijk M, Backus BE, Dekker IMC, Six AJ, Doevendans PA, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol. 2017;227:656-661. doi: 10.1016/j.ijcard.2016.10.080.
Gray AJ, Roobottom C, Smith JE, Goodacre S, Oatey K, O’Brien R, et al. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ. 2021;374. doi: 10.1136/bmj.n2106.
Stelzle D, Shah ASV, Anand A, Strachan FE, Chapman AR, Denvir MA, et al. High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study. Eur Heart J Qual Care Clin Outcomes. 2018;4(1):36-42. doi: 10.1093/ehjqcco/qcx022.
Chapman AR, Adamson PD, Shah ASV, Anand A, Strachan FE, Ferry AV, Lee KK, Berry C, Findlay I, Cruikshank A, Reid A, Gray A, Collinson PO, Apple F, McAllister DA, Maguire D, Fox KAA, Vallejos CA, Keerie C, Weir CJ, Newby DE, Mills NL. High-sensitivity cardiac troponin and the universal definition of myocardial infarction. Circulation. 2020;141(3):161-171. doi: 10.1161/CIRCULATIONAHA.119.042960.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Goiana Journal of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
