A multi-index diagnostic spectrum for acute myocardial infarction: incorporating the dual axes of inflammation and oxidative stress

Early and accurate diagnosis of acute myocardial infarction (AMI) is of great clinical significance for improving the prognosis of patients. Although high-sensitivity cardiac troponin (hs-cTn) is the current gold standard, it faces two key limitations: insufficient sensitivity in the ultra-early phase (<3 hours after symptom onset) due to its release kinetics, and suboptimal specificity in distinguishing ischemic from non-ischemic myocardial injury. In recent years, inflammation and oxidative stress, as the core links of the pathophysiology of AMI, have spawned a series of new biomarkers with potential diagnostic value. This article narrative reviews the biological characteristics, diagnostic efficacy, and risk stratification value of new markers such as S100A8/A9, damage-associated molecular patterns (DAMPs), myeloperoxidase (MPO), and heart-type fatty acid binding protein (H-FABP). Studies have shown that inflammation-related markers such as S100A8/A9 are significantly increased in the early stage of AMI and are independently associated with poor prognosis, such as heart failure. Oxidative stress-related markers such as MPO and H-FABP have earlier release kinetics (1-3 hours after symptom onset), which can make up for the blind window of hs-cTn. The area under the curve (AUC) for predicting 28-day mortality in STEMI patients using inflammatory biomarkers and the GRACE score was 0.8305. However, current studies still face translational barriers such as cohort heterogeneity, insufficient detection standardization and high cost, and large-scale multi-center validation is needed in the future.