Gemini SERS for Cross-Category Biomarker Detection and Early Warning of Sudden Cardiac Death in Acute Coronary Syndrome

)-mediated cascade. This strategy yields two spectrally distinct Raman signals within a single assay, enabling ratiometric and interference-free detection. Gemini achieves detection limits of 2.415 μM for pyruvate and 0.032 ng/mL for LDHB. When combined with a support vector machine (SVM) classifier, the platform accurately distinguishes ACS-SCD patients from healthy controls with 85% accuracy (90% sensitivity, 80% specificity), showing diagnostic performance comparable to conventional methods (AUC = 0.82 vs 0.79). This study demonstrates a multiplexed SERS framework for integrated metabolic-proteomic diagnostics and provides a clinically scalable strategy for early cardiovascular risk assessment. Moreover, the Gemini platform offers a broadly applicable paradigm for precision diagnostics across diverse pathophysiological conditions.