Emerging Novel Biomarkers in Acute Coronary Syndrome Management: Insights and Future Directions

Acute coronary syndrome (ACS), a primary manifestation of coronary artery disease (CAD), remains a leading cause of global mortality, particularly in low- and middle-income countries. Despite advances in diagnostics and therapy, accurate early risk stratification of ACS remains challenging. Traditional biomarkers such as cardiac troponins and CK-MB are essential for diagnosis but do not capture the full complexity of disease severity, particularly in cases involving inflammation, endothelial dysfunction and plaque instability. This review highlights emerging evidence regarding the roles of inflammatory cytokines and novel biomarkers in ACS pathophysiology, diagnosis and prognostication. Pro-inflammatory cytokines such as IL-6, IL-18 and TNF-α play key roles in atherogenesis and plaque destabilization, whereas anti-inflammatory mediators such as IL-10 and TGF-β decrease vascular injury. Novel biomarkers including Copeptin, GDF-15, microRNAs, sST2, Galectin-3, Endocan and MMP-9 offer enhanced prognostic capabilities and, in contrast to traditional biomarkers, often provide additional prognostic information in specific scenarios. Integrating these biomarkers with advanced risk models such as the GRACE score and digital health technologies, including AI, is transforming ACS management. However, challenges persist in standardization, cost-effectiveness, real-time implementation and interpretation in comorbid populations. This review emphasizes the potential of these biomarkers in improving personalized care and treatment for patients with ACS, while addressing evidence levels, clinical bottlenecks and integration strategies.