1. The Power of New Biomarkers to Detect Early Ischemia
CRT 2017, Washington, DC, USA
The Power of New Biomarkers
to Detect Early Ischemia
Thomas F. Lüscher, FESC, FRCP
Professor and Chairman Cardiology University Heart Center and
Director of Molecular Cardiology, University of Zürich, Switzerland

2. Disclosure Statement of Financial Interest
I, Thomas F. Luescher, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

3. The Power of New Biomarkers to Detect Early Ischemia
Definition of Myocardial Infarction
Diagnostic Value of Biomarkers
Prognostic Value of Biomarkers
Novel Biomarkers for CV Patients
Conclusion

4. The Power of New Biomarkers to Detect Early Ischemia
Definition of Myocardial Infarction
Diagnostic Value of Biomarkers
Prognostic Value of Biomarkers
Novel Biomarkers for CV Patients
Conclusion

5. Causes of Ischemia
Lüscher TF, Templin C.
Eur Heart J. 2016

6. Causes of Ischemia
Lüscher TF,
Templin C.
Eur Heart J. 2016

7. Definition of Myocardial Infarction
1. Symptoms
2. ECG
3 Biomarkers
4. Imaging
What do we need
Biomarkers for?
Diagnosis
Infarct Size
Prognosis

8. The Power of New Biomarkers to Detect Early Ischemia
Definition of Myocardial Infarction
Diagnostic Value of Biomarkers
Prognostic Value of Biomarkers
Novel Biomarkers for CV Patients
Conclusion

10. Troponins in ACS: The Guidelines

11. Troponins in ACS: The Guidelines
Thus, troponins are the gold standard in the diagnosis
of NSTEMI provided the clinical context is consistent

12. Troponins in ACS: The ESC Guidelines 2015:
The 0/3 hour Rule-in Rule-Out Algorythm

13. Troponins in ACS: The ESC Guidelines 2015
The 0/1 hour Rule-in Rule-Out Algorythm

14. Troponins in ACS: The Evidence for the
0/1 hour Rule-in Rule-Out Algorythm

15. The Power of New Biomarkers to Detect Early Ischemia
Definition of Myocardial Infarction
Diagnostic Value of Biomarkers
Prognostic Value of Biomarkers
Novel Biomarkers for CV Patients
Conclusion

18. The Power of New Biomarkers to Detect Early Ischemia
Definition of Myocardial Infarction
Diagnostic Value of Biomarkers
Prognostic Value of Biomarkers
Novel Biomarkers for CV Patients
Conclusion

19. Targeting inflammatory pathways for the treatment of cardiovascular disease
Targeting inflammatory pathways for the treatment of cardiovascular disease. Abbreviations: CCR2/CCR5, chemokine receptor types 2
and 5; CRP, C-reactive protein; FLAP, 5-liopoxygenase-activating protein; hsCRP, high-sensitivity C-reactive protein; ICAM-1, intercellular adhesion
molecule type 1; IL-1b, interleukin-1b; IL-18, interleukin-18; IL-6, interleukin-6; 5-LO, 5-lipoxygenase; Lp-PLA2, lipoprotein-associated phospholipase
A2; MMP-9, matirx metalloproteinase-9; PAI-1, plasminogen activator inhibitor type-1; SAA, serum amyloid A; SIRT1, sirtuin-1; sPLA2, secretory
phospholipse A2; TNF-a, tumour necrosis factor-a; and VCAM, vascular cellular adhesion molecule.
P. Ridker. Eur. Heart J. 2014;35: 540

20. Inflammatory Markers in Stable CAD and ACS
Maier, Altwegg et al. Circulation 2005

21. Interleukin-6 and serum amyloid A levels at the site of coronary occlusion and in the peripheral blood

24. Evolving Acute Myocardial Infarction
Inflammation, Plaque Destabilisation
Plaque Rupture, Coronary Occlusion
C-reactive protein
Interleukin-1b
Interleukin-6
Other cytokines
Troponins
Creatinin kinases
Myoglobin

25. The Power of New Biomarkers to Detect Early Ischemia
Definition of Myocardial Infarction
Diagnostic Value of Biomarkers
Prognostic Value of Biomarkers
Novel Biomarkers for CV Patients
Conclusion

26. The Power of New Biomarkers to Detect Early Ischemia
High-sensitive troponins are the gold standard for the detection of ischemia
They provide early information for diagnosis and risk stratification of ACS
Novel biomarkers of inflammation and thrombus formation hold promise for even earlier detection of patients at risk
Thank You!