Myocardial ischemia in nonobstructive coronary arteries: A review of diagnostic dilemmas, current perspectives, and emerging therapeutic innovations

Table 4 Biomarkers in atherosclerotic lesions

Biomarker	Description	Clinical significance
hs-CRP	hs-CRP is a sensitive marker of systemic inflammation and is elevated during plaque rupture or erosion	High hs-CRP levels reflect ongoing inflammation in the atherosclerotic plaque, promoting its instability and rupture
MMP-9	MMP-9 plays a key role in extracellular matrix degradation, which is involved in plaque rupture and erosion	MMP-9 degrades collagen and elastin in the plaque, weakening the fibrous cap and increasing the risk of rupture or erosion
CD40L	CD40L is involved in platelet activation and inflammation, playing a role in plaque rupture and thromboembolism	CD40L stimulates platelet aggregation and endothelial activation, contributing to plaque rupture and thromboembolism in MINOCA
P-selectin	P-selectin mediates platelet and endothelial cell interactions, playing a role in thromboembolism and plaque instability	P-selectin is involved in the recruitment of platelets to the site of plaque rupture or erosion, promoting thrombus formation

hs-CRP: High-sensitivity C-reactive protein; MMP-9: Matrix metalloproteinase-9; CD40L: CD40 ligand; MINOCA: Myocardial infarction with nonobstructive coronary arteries.