Vol. 6, Issue 1, Part A (2024)

Background: Acute myocardial infarction (AMI) remains one of the leading causes of global mortality and morbidity. Timely and accurate diagnosis is critical to initiate effective treatment and improve patient outcomes. While electrocardiography and imaging modalities are standard, biochemical markers—particularly serum enzymes—play a vital role in confirming myocardial injury.

Objective: This paper presents a comprehensive biochemical perspective on the use of serum enzyme profiles as predictive biomarkers in AMI. It explores their diagnostic kinetics, clinical significance, and integration into multi-marker strategies.

Methods & Content Overview: We review classical and modern biomarkers including creatine kinase-MB (CK-MB), cardiac troponins (cTnI and cTnT), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and emerging markets such as heart-type fatty acid binding protein (H-FABP), copeptin, ischemia-modified albumin (IMA), myeloperoxidase (MPO), and GPBB. The pathophysiology of enzyme release is discussed in relation to infarct timing and myocardial necrosis. Comparative analysis outlines each biomarker’s rise time, peak, half-life, specificity, and clinical application. The study also highlights the advantages of multi-marker strategies in early detection and risk stratification.

Results & Significance: Troponins were reaffirmed as the gold standard due to their high specificity and long diagnostic window, while early-rising markers like H-FABP and copeptin demonstrated value in pre-hospital and emergency triage settings. Prognostic relevance was established for markers such as MPO and persistent troponin elevation, which correlate with infarct size, reinfarction risk, and long-term outcomes.

Conclusion: Serum biomarkers, when interpreted in the context of clinical findings and used in a time-sensitive, multi-marker approach, offer a powerful framework for diagnosing, managing, and prognosticating AMI. Understanding their kinetics, limitations, and complementary roles is essential for delivering precise and timely cardiac care.