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Clinical Chemistry 53: 545-546, 2007. First published March 23, 2007; 10.1373/clinchem.2006.079749
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(Clinical Chemistry. 2007;53:545-546.)
© 2007 American Association for Clinical Chemistry, Inc.

Evidence-Based Laboratory Medicine and Test Utilization

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Utilization of Biochemical Markers in Acute Coronary Syndromes and Heart Failure

Robert H. Christenson

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Utilization of Biochemical Markers in Acute Coronary Syndromes and Heart Failure, University of Maryland School of Medicine, Baltimore, MD


   Preamble
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 Preamble
References
 
The National Academy of Clinical Biochemistry’s (NACB) Laboratory Medicine Practice Guidelines (LMPG) for use of cardiac markers in coronary artery diseases were published in July 1999 (1). Since production of this initial document, numerous published studies and presented data have added significantly to the knowledge base for biochemical markers of cardiac injury. This increased knowledge has substantially expanded the scope of recommendations for biochemical marker utilization since the 1999 document, and in particular has required the inclusion of recommendations regarding biochemical markers that extend beyond myocardial necrosis. Toward addressing these advances and their impact on biochemical marker utilization in clinical practice, the NACB appointed a chair and members of an LMPG committee that was charged with revising and extending the earlier recommendations by establishing modern guidelines for Utilization of Biochemical Markers in Acute Coronary Syndromes and Heart Failure. These extended recommendations include Clinical Utilization of Biochemical Markers in Acute Coronary Syndromes (ACS); Analytical Issues of ACS Biochemical Markers; Clinical Utilization of Biochemical Markers of Heart Failure and Hemodynamic Stress; Analytical Issues of Heart Failure Biochemical Markers; Point-of-Care Testing and Logistics; and Cardiac Biomarkers and Other Etiologies. Updated draft revisions of the Guidelines were prepared and placed for comment on the NACB World Wide Web site (http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/DraftGuidelines/BioHearFailure/) in August of 2004. The draft LMPG and suggested revisions were also presented for public and stakeholder comment at the October 2004 Arnold O. Beckman Conference titled Cardiac Markers: Establishing Guidelines and Improving Results.

The articles presented here provide the NACB’s updated recommendations for the rapidly evolving topics of Clinical Utilization of Biochemical Markers in Acute Coronary Syndromes and Analytical Issues for Biochemical Markers of Acute Coronary Syndromes. The later of these documents represents a joint effort between the NACB and the International Federation of Clinical Chemistry’s Committee on Standardization of Markers of Cardiac Damage. The remaining sections involving other clinical and analytical issues for utilization of biochemical markers of cardiac injury are available at http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/PublishedGuidelines.

The strength of scientific data supporting each recommendation is characterized using the scoring criteria adopted from the American Heart Association/American College of Cardiology as summarized in Table 1 . For each recommendation, the designations I, IIa, IIb, and III describe the indications, and the upper-case letters A through C describe the weight of evidence. Levels of evidence listed in the guidelines were determined by the full writing committee. Ratings were discussed in detail until consensus of the full writing committee was reached. There was no process for recusal. The members of the committee have reported all relevant relationships with industry to be published with these guidelines.


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  		Table 1. American College of Cardiology/American Heart Association Classifications.

These guidelines were developed utilizing best available evidence, and they incorporated substantial input from acknowledged experts and professional organizations. As such, they represent the current best practice for utilization of biochemical markers of cardiac injury.


   Acknowledgments
 
Financial Disclosures: The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines Committee for Utilization of Biomarkers in Acute Coronary Syndromes and Heart Failure reports all reported relationships within the 2 years previous to this publication that may be relevant to this guidelines document. A document of those relationships may be found in the online Data Supplement at http://www.clinchem.org/content/vol53/issue4.


   Footnotes
 
This article has been copublished in the April 3, 2007 online issue of Circulation.


   References
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 References
 

  1. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R, Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem 1999;45:1104-1121.[Abstract/Free Full Text]




This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Financial Disclosures
Right arrow All Versions of this Article:
clinchem.2006.079749v1
53/4/545    most recent
Right arrow Submit an electronic Letter to
the Editor about this paper
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Christenson, R. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Christenson, R. H.
Related Collections
Right arrow Evidence Based Laboratory Medicine and Test Utilization
Right arrow Proteomics and Protein Markers
Right arrow National Academy of Clinical Biochemistry

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