Diagnostic Utility of Inflammatory and Matrix Remodeling Biomarkers (HsCRP, H-FABP, MMP-9 and PAPP-A) in Patients with Acute Coronary Syndrome: A Case–Control Study

Background: Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide. Early identification of myocardial injury and plaque instability is critical for timely management. Biomarkers reflecting inflammation and extracellular matrix remodeling may improve early detection of ACS. The aim is to evaluate the role of selected cardiac and inflammatory biomarkers (hsCRP, H-FABP, PAPP-A, and MMP-9) in patients with acute coronary syndrome and to compare their levels with those of healthy controls. Material and Methods: A case–control study was conducted involving 110 patients diagnosed with acute coronary syndrome and 110 age- and sex-matched healthy controls. Serum levels of high-sensitivity C-reactive protein (HsCRP), heart-type fatty acid-binding protein (H-FABP), matrix metalloproteinase-9 (MMP-9), and pregnancy-associated plasma protein-A (PAPP-A) were measured using standardized biochemical methods. Conventional cardiac biomarkers, including creatine kinase-MB (CK-MB), Troponin-I, and ischemia-modified albumin (IMA), were also evaluated. Statistical comparisons were performed between groups. Results: Male predominance was observed in both groups. Smoking and alcohol consumption were significantly associated with ACS (p < 0.001 and p < 0.05, respectively). The mean BMI was significantly higher in the ACS group (26.31 ± 4.32 kg/m²) compared to controls (23.37 ± 3.13 kg/m², p < 0.001). Hypertension was the most common comorbidity among ACS patients (46.4%). HDL levels were significantly lower, while systolic and diastolic blood pressure were significantly higher in ACS patients (p < 0.001). Inflammatory and cardiac biomarkers, including hsCRP (4.8 ± 1.59 vs. 0.47 ± 0.25), H-FABP (36.79 ± 4.26 vs. 0.54 ± 0.26), PAPP-A (65.37 ± 1.05 vs. 10.86 ± 1.04 ng/ml), and MMP-9 (4000 vs. 87 pg/mL), were significantly elevated in ACS patients compared to controls (p < 0.001). Conventional cardiac biomarkers such as CK-MB, Troponin-I, and IMA were also elevated, confirming myocardial injury. Conclusion: The study demonstrates that inflammatory and cardiac biomarkers, particularly hsCRP, H-FABP, PAPP-A, and MMP-9, are significantly elevated in patients with acute coronary syndrome and may serve as valuable tools for early diagnosis and risk stratification. The integration of novel biomarkers with conventional cardiac markers may enhance diagnostic accuracy and improve clinical management of AC.