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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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