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Clinical Chemistry 45: 1104-1121, 1999;
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(Clinical Chemistry. 1999;45:1104-1121.)
© 1999 American Association for Clinical Chemistry, Inc.

Articles

National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases

Alan H.B. Wu1,a, Fred S. Apple2, W. Brian Gibler3, Robert L. Jesse4, Myron M. Warshaw5 and Roland Valdes, Jr.6

1 NACB Committee Chair, Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102.

2 Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and the University of Minnesota, Minneapolis, MN 55415.

3 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267.

4 Division of Cardiology, McGuire Veterans Administration Medical Center and the Virginia Commonwealth University/Medical College of Virginia, Richmond, VA 23225.

5 Department of Pathology, Northwest Community Hospital, Arlington Heights, IL 60005.

6 Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40292.

7 Listed with each recommendation is the degree of evidence from the literature and/or agreement from the consensus of participants who attended either presentation. Using a modified classification scheme defined by the American College of Cardiology/American Heart Association (AHA/ACC), the NACB Committee defined a Class I recommendation as one for which there is evidence and/or general agreement; a Class II recommendation as one for which there is conflicting evidence and/or a divergence of opinion about its usefulness/efficacy, but where the weight of evidence/opinion is in its favor; and a Class III recommendation as one for which there is evidence and/or general agreement that a procedure is not useful or effective (4).
a Address correspondence to this author at: Hartford Hospital, Department of Pathology, 80 Seymour St., Hartford, CT 06102. Fax 860-545-3733; e-mail awu{at}harthosp.org

The Sixth Conference on the "Standards of Laboratory Practice Series", sponsored by the National Academy of Clinical Biochemistry (NACB), was held on August 4–5, 1998, at the Annual Meeting of the American Association for Clinical Chemistry, in Chicago, IL. An expert committee was assembled to write recommendations on the use of cardiac markers in coronary artery diseases. The NACB Committee prepared a preliminary draft of the guidelines, made them available on the World Wide Web (www.nacb.org), and distributed them before the presentations. The recommendations were divided into four areas: the use of markers in the triage of patients with chest pain, acute coronary syndromes, clinical applications other than acute myocardial infarction and research, and assay platforms and markers of acute myocardial infarction. The recommendations were revised and subsequently re-presented in part at the "Biomarkers in Acute Cardiac Syndromes Conference", sponsored by the Jewish Hospital Heart and Lung Institute, Louisville KY, on October 16–17, 1998. This report lists each recommendation, its scientific justification, and a summary of discussions from conference participants and reviewers.

Approximately 100 individuals responded to various versions of these recommendations via direct correspondences, telephone calls to Committee members, electronic mail correspondence to the Committee Chairman, or oral questions and comments raised during one of the two conference presentations. Some of the recommendations were changed to reflect the consensus opinion. In cases in which there was no consensus, the Committee included pertinent discussion without necessarily changing the original recommendations. At times, the Committee members felt that although a particular recommendation might not be the current standard of care today, they anticipate that it likely will be adopted in the near future.




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F. S. Apple, A. S. Jaffe, L. K. Newby, A. L. Kaplan, R. H. Tuttle, S. E. McNulty, E. M. Ohman, A. B. Storrow, W. B. Gibler, J. L. Garvey, et al.
Bedside Multimarker Testing for Risk Stratification in Chest Pain Units: The Chest Pain Evaluation by Creatine Kinase-MB, Myoglobin, and Troponin I (CHECKMATE) Study Response
Circulation, November 27, 2001; 104 (22): e125 - e126.
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 The Journal of the Royal Society for the Promotion of HealthHome page
A. Olukoga and D. Donaldson
An overview of biochemical markers in acute coronary syndromes
Perspectives in Public Health, June 1, 2001; 121(2): 102 - 106.
[Abstract] [PDF]

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 Clin. Chem.Home page
F. S. Apple and A. H.B. Wu
Myocardial Infarction Redefined: Role of Cardiac Troponin Testing
Clin. Chem., March 1, 2001; 47(3): 377 - 379.
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 Clin. Chem.Home page
J. C.J.M. Swaanenburg, B. G. Loef, M. Volmer, P. W. Boonstra, J. G. Grandjean, M. A. Mariani, and A. H. Epema
Creatine Kinase MB, Troponin I, and Troponin T Release Patterns after Coronary Artery Bypass Grafting with or without Cardiopulmonary Bypass and after Aortic and Mitral Valve Surgery
Clin. Chem., March 1, 2001; 47(3): 584 - 587.
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 HeartHome page
R Bholasingh, R J de Winter, J C Fischer, R W Koster, R J G Peters, and G T Sanders
Safe discharge from the cardiac emergency room with a rapid rule-out myocardial infarction protocol using serial CK-MBmass
Heart, February 1, 2001; 85(2): 143 - 148.
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 CirculationHome page
J. L. McDonough, R. Labugger, W. Pickett, M. Y. Tse, S. MacKenzie, S. C. Pang, D. Atar, G. Ropchan, and J. E. Van Eyk
Cardiac Troponin I Is Modified in the Myocardium of Bypass Patients
Circulation, January 2, 2001; 103(1): 58 - 64.
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 J Am Coll CardiolHome page
D. A. Morrow, E. M. Antman, M. Tanasijevic, N. Rifai, J. A. de Lemos, C. H. McCabe, C. P. Cannon, and E. Braunwald
Cardiac troponin I for stratification of early outcomes and the efficacy of enoxaparin in unstable angina: a TIMI-11B substudy
J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1812 - 1817.
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 J Am Coll CardiolHome page
M. C. Kontos, F. P. Anderson, R. Alimard, J. P. Ornato, J. L. Tatum, and R. L. Jesse
Ability of troponin I to predict cardiac events in patients admitted from the emergency department
J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1818 - 1823.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
R. J. de Winter
Risk stratification with cardiac troponin I in acute coronary syndromes
J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1824 - 1826.
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 Clin. Chem.Home page
F. S. Apple, F. P. Anderson, P. Collinson, R. L. Jesse, M. C. Kontos, M. A. Levitt, E. A. Miller, and M. M. Murakami
Clinical Evaluation of the First Medical Whole Blood, Point-of-Care Testing Device for Detection of Myocardial Infarction
Clin. Chem., October 1, 2000; 46(10): 1604 - 1609.
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 Clin. Chem.Home page
M. Zaninotto, F. Pagani, S. Altinier, P. Amboni, R. Bonora, A. Dolci, P. Pergolini, A. Vernocchi, M. Plebani, M. Panteghini, et al.
Multicenter Evaluation of Five Assays for Myoglobin Determination
Clin. Chem., October 1, 2000; 46(10): 1631 - 1637.
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 CirculationHome page
A. S. Jaffe, J. Ravkilde, R. Roberts, U. Naslund, F. S. Apple, M. Galvani, and H. Katus
It's Time for a Change to a Troponin Standard
Circulation, September 12, 2000; 102(11): 1216 - 1220.
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 Eur Heart JHome page
Myocardial
Myocardial infarction redefined--A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction
Eur. Heart J., September 2, 2000; 21(18): 1502 - 1513.
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 J Am Coll CardiolHome page
E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al.
ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina)
J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062.
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 Clin. Chem.Home page
H. Stiegler, Y. Fischer, J. F. Vazquez-Jimenez, J. Graf, K. Filzmaier, B. Fausten, U. Janssens, A. M. Gressner, and D. Kunz
Lower Cardiac Troponin T and I Results in Heparin-Plasma Than in Serum
Clin. Chem., September 1, 2000; 46(9): 1338 - 1344.
[Abstract] [Full Text] [PDF]

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 Clin. Chem.Home page
S. Altinier, M. Mion, A. Cappelletti, M. Zaninotto, and M. Plebani
Rapid Measurement of Cardiac Markers on Stratus CS
Clin. Chem., July 1, 2000; 46(7): 991 - 993.
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 Clin. Chem.Home page
F. Pagani, G. Bonetti, F. Stefini, C. Cuccia, M. Panteghini, B. Bluestein, B. Markham, and D. Waskiewicz
Serum and Plasma Samples for ACS:Systems Cardiac Markers Representatives of the manufacturer respond:
Clin. Chem., July 1, 2000; 46(7): 1020 - 1022.
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 Clin. Chem.Home page
W. Gerhardt, G. Nordin, A.-K. Herbert, B. Linaker Burzell, A. Isaksson, E. Gustavsson, S. Haglund, M. Muller-Bardorff, and H. A. Katus
Troponin T and I Assays Show Decreased Concentrations in Heparin Plasma Compared with Serum: Lower Recoveries in Early than in Late Phases of Myocardial Injury
Clin. Chem., June 1, 2000; 46(6): 817 - 821.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
L.-M. Voipio-Pulkki, P. Porela, H. Helenius, and K. Pulkki
A reply
Eur. Heart J., May 2, 2000; 21(10): 858 - 858.
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 Clin. Chem.Home page
J. Ravkilde
Risk Stratification in Acute Coronary Syndrome Using Cardiac Troponin I
Clin. Chem., April 1, 2000; 46(4): 443 - 444.
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 Clin. Chem.Home page
D. A. Morrow, N. Rifai, M. J. Tanasijevic, D. R. Wybenga, J. A. de Lemos, and E. M. Antman
Clinical Efficacy of Three Assays for Cardiac Troponin I for Risk Stratification in Acute Coronary Syndromes: A Thrombolysis In Myocardial Infarction (TIMI) 11B Substudy
Clin. Chem., April 1, 2000; 46(4): 453 - 460.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
G. A. Ewy and J. P. Ornato
Emergency cardiac care: introduction
J. Am. Coll. Cardiol., March 15, 2000; 35(4): 825 - 880.
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