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## Complete Summary

#### GUIDELINE TITLE

National Academy of Clinical Biochemistry laboratory medicine practice
guidelines: Use of cardiac troponin and B-type natriuretic peptide or
N-terminal proB-type Natriuretic Peptide for Etiologies other than acute
coronary syndromes and heart failure.

#### BIBLIOGRAPHIC SOURCE(S)

Wu AH, Jaffe AS, Apple FS, Jesse RL, Francis GL, Morrow DA, Newby LK,
Ravkilde J, Tang WH, Christenson RH, Cannon CP. National Academy of
Clinical Biochemistry laboratory medicine practice guidelines: use of
cardiac troponin and B-type natriuretic peptide or N-terminal proB-type
natriuretic peptide for etiologies other than acute coronary syndromes
and heart failure. Clin Chem 2007 Dec 1;53(12):2086-96. \[109
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17954494)

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: 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
Jul;45(7):1104-21. \[119 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10388496)

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s)/intervention(s) for which important revised
regulatory and/or warning information has been released.

-   [June 8, 2007, Troponin-I
    Immunoassay](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Architect):
    Class I Recall of all lots of the Architect Stat Troponin-I
    Immunoassay. The assay may report falsely elevated or falsely
    decreased results at and near a low level, which may impact patient
    treatment.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Chronic renal failure

-   Other non-ischemic etiologies, such as:

    -   Blunt chest trauma

    -   Critical illness

    -   Congestive heart failure

    -   Pulmonary embolism

    -   Sepsis

    -   Myocarditis

-   Cancer being treated with cardiotoxic chemotherapies

-   Conditions and diseases requiring non-cardiac surgery, such as
    vascular surgery

-   Conditions and diseases requiring percutaneous coronary intervention
    (PCI)

-   Conditions and diseases requiring cardiac surgery

-   Conditions or diseases without overt ischemic heart disease where
    cardiac troponins may be elevated (refer to Table 6-1 in the
    original guideline document)

-   Conditions or diseases without overt heart failure where
    concentrations of B-type natriuretic peptide/N-terminal B-type
    natriuretic peptide (BNP/NT-proBNP) may be increased (refer to Table
    6-2 in the original guideline document)

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Risk Assessment

#### CLINICAL SPECIALTY

Cardiology\
Critical Care\
Emergency Medicine\
Family Practice\
Internal Medicine\
Nephrology\
Oncology\
Pathology\
Pulmonary Medicine\
Surgery\
Thoracic Surgery

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Clinical Laboratory Personnel\
Emergency Medical Technicians/Paramedics\
Health Care Providers\
Hospitals\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To present recommendations on the interpretation of cardiac troponins
(cTn) and the natriuretic peptides in etiologies other than acute
coronary syndromes and heart failure

#### TARGET POPULATION

Patients with conditions or diseases other than acute coronary syndrome
and heart failure that may affect changes in cardiac biomarkers

#### INTERVENTIONS AND PRACTICES CONSIDERED

Use of cardiac troponin (cTn) and B-type natriuretic peptide (BNP) or
N-terminal proB-type natriuretic peptide (NT-proBNP) in specific
settings (e.g., evaluation of chronic renal failure, non-ischemic
etiologies, post-surgery and post percutaneous coronary intervention
\[PCI\])

#### MAJOR OUTCOMES CONSIDERED

Usefulness/efficacy of cardiac biomarker utilization in specific
settings for diagnosis and/or risk assessment of morbidity, mortality,
and adverse cardiac events

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Searches of Electronic Databases\
Searches of Unpublished Data

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

These National Academy of Clinical Biochemistry (NACB) guidelines were
developed rigorously; however it was possible to include only papers
published in the English language. The specified method for developing
the evidence base for recommendations listed involved use of PubMed,
EMBASE, and other databases that were not necessarily published.
Systematic methods were used whenever available; searches were first set
to be sensitive to avoid missing papers of possible interest, and then
narrowed to sort through the literature in order to enhance specificity.
The writing group contacted recognized experts to assure that important
evidence had not been missed.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Weight of Evidence**

**A** - Data derived from multiple randomized or appropriately designed
clinical trials that involved large numbers of patients

**B** - Data derived from a limited number of randomized or
appropriately designed trials that involved small numbers of patients or
from careful analyses of observational registries

**C** - Expert Consensus was the primary basis for the recommendation

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

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 of 1999. Since
production of this initial document, numerous published studies and
presented data have added significantly to the knowledge base for
cardiac biomarkers. This increased knowledge has substantially expanded
the scope of recommendations for cardiac biomarker utilization since the
1999 document, and in particular has required the inclusion of
recommendations regarding biomarkers that extend beyond myocardial
necrosis. Toward addressing these advances and their impact on biomarker
utilization in clinical practice, the NACB appointed a chair and members
of a LMPG committee that was charged with the overall objective of
revising and extending the earlier recommendations by establishing
modern guidelines for Utilization of Biomarkers in Acute Coronary
Syndrome and Heart Failure. This LMPG is aimed at providing analytical
and clinical guidance for the measurement and interpretation of cardiac
biochemical markers of acute coronary syndromes (ACS), heart failure and
point-of-care measurement and logistics of providing ACS biomarker data
for patient care; guidance for interpretation of biomarkers in
etiologies other than ACS and Heart Failure is included as well.

These guidelines and their recommendations are structured into six
chapters that include Chapter 1: Clinical Utilization of Biomarkers in
Acute Coronary Syndromes (ACS); Chapter 2: Analytical Issues of ACS
Biomarkers; Chapter 3: Clinical Utilization of Biomarkers of Heart
Failure; Chapter 4: Analytical Issues of Heart Failure Biomarkers;
Chapter 5: Point of Care Testing and Logistics; and Chapter 6: Cardiac
Biomarkers and Other Etiologies. Each chapter was spearheaded by a
writing group, which was a subset of the overall committee. In addition,
other ad hoc expertise contributed to the writing group of some
subsections and chapters to optimize the content and quality of the
guidelines. The \"questions\" for each chapter are in the form of issues
addressed and specified in the organization of each individual chapter.
The chapter design of the guidelines was used to facilitate finding
guidance by users; this format was also used, in part, to provide an
easy and focused procedure for updating the guidelines in the future.
Also, the chapter design allowed publication of sections in appropriate
laboratory medicine and clinical specialty journals.

Stakeholder involvement in development and refinement of these
guidelines was substantial. The guideline team was comprised of
laboratory medicine, ACS cardiology experts, and heart failure
cardiology experts. As these guidelines target acutely ill patients,
Emergency Medicine stakeholders were represented by a specialist; it is
also noteworthy that all of the laboratory professionals and cardiology
experts on the guideline committee have substantial interaction,
knowledge, and publications in the area of laboratory and clinical
medicine in the Emergency Medicine environment.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Modified American College of Cardiology/American Heart Association
Classifications: Summary of Indications**

**Class I**: Conditions for which there is evidence and/or general
agreement that a given laboratory procedure or treatment is useful and
effective.

**Class II**: Conditions for which there is conflicting evidence and/or
a divergence of opinion about the usefulness/efficacy of a laboratory
procedure or treatment.

**Class IIa**: Weight of evidence/opinion is in favor of
usefulness/efficacy.

**Class IIb**: Usefulness/efficacy is less well established by
evidence/opinion.

**Class III**: Conditions for which there is evidence and/or general
agreement that the laboratory procedure/treatment is not
useful/effective and in some cases may be harmful.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Stakeholder involvement in development and refinement of these
guidelines was substantial. To further enhance stakeholder input, draft
revisions of the Guidelines were prepared and placed for comment on the
National Academy of Clinical Biochemistry (NACB) World Wide Web site
(<http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/DraftGuidelines/BioHearFailure/>).
The draft Laboratory Medicine Practice Guidelines (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*. Refer to Table 1 of the
Preamble to the original guideline document for a list of the various
stakeholder groups that agreed to examine the documents and were
represented at the conference.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Definitions of the weight of evidence (A-C) and the summary of
indications (Classes I, II, IIa, IIb, III) are presented at the end of
the \"Major Recommendations\" field.

***Note from the National Academy of Clinical Biochemistry (NACB) and
the National Guideline Clearinghouse (NGC)**: The Laboratory Medicine
Practice Guidelines (LMPG) for utilization of biochemical markers in
acute coronary syndromes and heart failure* have been divided into
individual summaries. In addition to the current summary, the following
are available:

-   [Chapter 1: Clinical characteristics and utilization of biochemical
    markers in acute coronary
    syndromes](http://www.guideline.gov/summary/summary.aspx?doc_id=11692&nbr=006039)

-   [Chapter 2: Analytical issues for biochemical markers of acute
    coronary
    syndromes](http://www.guideline.gov/summary/summary.aspx?doc_id=11693&nbr=006040)

-   [Chapter 3: Clinical utilization of cardiac biomarker testing in
    heart
    failure](http://www.guideline.gov/summary/summary.aspx?doc_id=11694&nbr=006041)

-   [Chapter 4: Analytical issues for biomarkers of heart
    failure](http://www.guideline.gov/summary/summary.aspx?doc_id=11695&nbr=006042)

-   [Chapter 5: Point of care testing, oversight and administration of
    cardiac biomarkers for acute coronary
    syndromes](http://www.guideline.gov/summary/summary.aspx?doc_id=11696&nbr=006043)

**[Use of Cardiac Biomarkers in the Evaluation of Patients with Chronic
Renal Failure]{.underline}**

**Utilization of Cardiac Biochemical Marker in the Setting of Chronic
Renal Failure**

Recommendations for use of biochemical markers in the setting of chronic
renal failure

***Class I***

1.  In renal failure patients with symptoms (e.g., acute chest pain),
    electrocardiographic (ECG) or other clinical evidence suggesting
    myocardial ischemia, measurement of cardiac troponin (cTn) is
    warranted for evaluation of myocardial infarction (MI). **(Level of
    Evidence A)**

2.  For end-stage renal disease (ESRD) patients, as for all patients who
    may have baseline elevations of cTn, who present with possible acute
    coronary syndrome (ACS), relying on dynamic changes in the cTn
    values of 20% or more should be used to define those with acute
    myocardial infarction. **(Level of Evidence B)**

***Class IIb***

1.  cTnT and cTnI can be used as aids for defining the risk for
    mortality in ESRD patients and to provide baseline values for
    comparison when measured in the setting of an acute clinical change.
    **(Level of Evidence B)**

2.  In renal failure patients, B-type natriuretic peptide (BNP) or
    N-terminal B-type natriuretic peptide (NT-proBNP) testing can be
    used in the acute setting to *rule out* or to *confirm* the
    diagnosis of heart failure among patients presenting with ambiguous
    signs and symptoms. However different decision point (cutoff) values
    must be used compared to patients with estimated glomerular
    filtration rate \>60 mL/min/1.73m^2^. **(Level of Evidence B)**

***Class III***

1.  Routine BNP/NT-proBNP measurement is not warranted in asymptomatic
    end-stage renal disease patients. **(Level of Evidence B)**

**[Use of Biomarkers in the Evaluation of Other Non-Ischemic
Etiologies]{.underline}**

**Use of Cardiac Biomarkers in the Setting Non-ischemic Etiologies**

Recommendations for use of biochemical markers in other non-ischemic
etiologies

***Class IIb***

1.  Increased cardiac telemetry may be warranted for patients who have
    increased cTn values following blunt chest trauma. **(Level of
    Evidence B)**

2.  The measurement of cTn can be used to define risk among patients who
    are critically ill. **(Level of Evidence A)**

3.  Increased cTn values identify individuals at increased risk for the
    development of congestive heart failure when treated with adriamycin
    therapy for cancer. **(Level of Evidence B)**

4.  Increased cTn values identify individuals at increased risk with
    acute pulmonary embolism. **(Level of Evidence B)**

5.  Routine BNP/NT-proBNP measurements may be warranted among patients
    with non-ischemic etiologies such as sepsis, myocarditis, or
    pulmonary embolism. **(Level of Evidence C)**

***Class III***

1.  Release of cTn from patients with cancer undergoing cardiotoxic
    chemotherapies represents myocardial damage, which may be associated
    with a worse prognosis **(Level of Evidence B)**. However routine
    cTnT or cTnI measurements are not warranted among cancer patients
    undergoing chemotherapies that are toxic to the heart (except those
    receiving adriamycin). **(Level of Evidence C)**

**[Use of Biomarkers after Non-cardiac Surgery]{.underline}**

**Use of Cardiac Biochemical Markers After Non-cardiac Surgery**

Recommendations for use of cardiac markers after non-cardiac surgery

***Class IIb***

1.  cTnT and cTnI are recommended for patients undergoing non-cardiac
    surgery if there is a question of cardiac ischemia. Cutoff
    concentrations that are used for diagnosis of MI are appropriate.
    **(Level of Evidence C)**

2.  cTnT and cTnI are recommended for post-surgical assessment of
    patients undergoing vascular surgery given the high frequency of
    underlying coronary artery disease and associated perioperative
    events. Such increases appear to be due to ischemia and are highly
    prognostic for both short- and long-term mortality. Cutoff
    concentrations that are used for diagnosis of MI are appropriate.
    **(Level of Evidence B)**

3.  Increases of cTn post operatively are associated with adverse
    prognosis and should prompt clinical follow up. **(Level of Evidence
    B)**

***Class III***

1.  Routine BNP/NT-proBNP measurements are not warranted among patients
    undergoing non-cardiac surgery. **(Level of Evidence C)**

**[Biomarker Use after Percutaneous Coronary Intervention
(PCI)]{.underline}**

**Use of Cardiac Biochemical Markers after PCI**

Recommendations for use of biomarkers after PCI

***Class IIb***

1.  It is appropriate to measure cTnT or cTnI before and after
    percutaneous coronary intervention to determine the presence of
    ischemic cardiac damage if the baseline pre-procedural value is less
    than 99th percentile for the reference control population. Any
    increase is indicative of cardiac damage. However, there is
    currently insufficient evidence to recommend the specific cTn cutoff
    concentration. **(Level of Evidence C)**

***Class III***

1.  Routine BNP/NT-proBNP measurements are not warranted among patients
    undergoing PCI. **(Level of Evidence C)**

2.  If the pre-procedural baseline cTn is increased above the 99th
    percentile of a reference control population, then biochemical
    markers should not be used to estimate whether increases are related
    to the procedure or to progression of the underlying disease state
    that caused the need for the procedure. If serial preprocedural cTn
    values are available, a falling trend followed by a post-procedural
    increase of 20% or more may be indicative of new myocardial injury,
    even if any or all of the pre-procedural results are above the 99th
    percentile. **(Level of Evidence C)**

**[Use of Biomarkers after Cardiac Surgery]{.underline}**

**Use of Cardiac Biochemical Markers after Cardiac Surgery**

Recommendations for use of biomarkers after cardiac surgery

***Class IIa***

1.  The higher the cTn values post operatively, the greater the risk of
    adverse cardiac events. **(Level of Evidence B)**

2.  In addition to greater than 5-fold increase in cTn after the
    procedure, clinical and other (non-lab medicine) diagnostic testing
    criteria should be used to distinguish components related to the
    operative procedure and cardioprotection from vascular events.
    **(Level of Evidence C)**

3.  Preprocedural baseline cTn increases help to define risk among
    patients undergoing cardiac surgery. **(Level of Evidence C)**

***Class III***

1.  At this time, there is insufficient evidence to recommend routine
    measurement of BNP/NT-proBNP before or after cardiac surgery.
    **(Level of Evidence C)**

**[Definitions]{.underline}**:

**Weight of Evidence**

**A** - Data derived from multiple randomized or appropriately designed
clinical trials that involved large numbers of patients

**B** - Data derived from a limited number of randomized or
appropriately designed trials that involved small numbers of patients or
from careful analyses of observational registries

**C** - Expert Consensus was the primary basis for the recommendation

**Summary of Indications**

**Class I**: Conditions for which there is evidence and/or general
agreement that a given laboratory procedure or treatment is useful and
effective.

**Class II**: Conditions for which there is conflicting evidence and/or
a divergence of opinion about the usefulness/efficacy of a laboratory
procedure or treatment.

**Class IIa**: Weight of evidence/opinion is in favor of
usefulness/efficacy.

**Class IIb**: Usefulness/efficacy is less well established by
evidence/opinion.

**Class III**: Conditions for which there is evidence and/or general
agreement that the laboratory procedure/treatment is not
useful/effective and in some cases may be harmful.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate utilization of biochemical markers for evaluation and risk
stratification in settings other than acute coronary syndromes (ACS) and
heart failure (HF)

#### POTENTIAL HARMS

False positive increases in cardiac troponin (cTn), B-type natriuretic
peptide (BNP) and N-terminal B-type natriuretic peptide (NT-proBNP) can
occur, although very infrequently, as a result of analytical errors.
Although the incidence of assay interferences caused by atypical
antibodies has been reduced, all immunoassays have the potential for
both false positive and false negative interferences.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The materials in this publication represent the opinions of the authors
and committee members, and do not represent the official position of the
National Academy of Clinical Biochemistry (NACB). The National Academy
of Clinical Biochemistry is the academy of the American Association for
Clinical Chemistry.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Wu AH, Jaffe AS, Apple FS, Jesse RL, Francis GL, Morrow DA, Newby LK,
Ravkilde J, Tang WH, Christenson RH, Cannon CP. National Academy of
Clinical Biochemistry laboratory medicine practice guidelines: use of
cardiac troponin and B-type natriuretic peptide or N-terminal proB-type
natriuretic peptide for etiologies other than acute coronary syndromes
and heart failure. Clin Chem 2007 Dec 1;53(12):2086-96. \[109
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17954494)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 Jul (revised 2007 Dec)

#### GUIDELINE DEVELOPER(S)

National Academy of Clinical Biochemistry - Professional Association

#### SOURCE(S) OF FUNDING

National Academy of Clinical Biochemistry

#### GUIDELINE COMMITTEE

The National Academy of Clinical Biochemistry

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*National Academy of Clinical Biochemistry (NACB) Writing Group
Members*: Alan B. Storrow, MD, Section Leader; Fred S. Apple, PhD; Alan
H.B. Wu, PhD; Robert L. Jesse, MD, PhD; Gary S. Francis, MD; Robert H.
Christenson, PhD

*NACB Committee Members*: Robert H. Christenson, *Chair*, University of
Maryland School of Medicine, Baltimore, Maryland, USA; Fred S. Apple,
Hennepin County Medical Center and University of Minnesota, Minneapolis,
Minnesota, USA; Christopher P. Cannon, Brigham and Women\'s Hospital,
Boston, Massachusetts, USA; Gary S. Francis, Cleveland Clinic
Foundation, Cleveland, Ohio, USA; Robert L. Jesse, Medical College of
Virginia, Richmond, Virginia, USA; David A. Morrow, Brigham and Women\'s
Hospital, Boston, Massachusetts, USA; L. Kristin Newby, Duke University
Medical Center, Durham, North Carolina, USA; Jan Ravkilde, Aarhus
University Hospital, Aarhus, Denmark; Alan B. Storrow, Vanderbilt
University, Nashville, Tennessee, USA; W. H. Wilson Tang, Cleveland
Clinic Foundation, Cleveland, Ohio, USA; Alan H. B. Wu, San Francisco
General Hospital and University of California at San Francisco, San
Francisco, California, USA

*Ad Hoc members of the committee for selected sections*: Allan S. Jaffe,
Mayo Clinic, Rochester, Minnesota, USA; Alan S. Maisel, University of
California at San Diego, San Diego, California, USA; Mauro Panteghini,
University of Milan, Milan, Italy

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Other than modest funding from the National Academy of Clinical
Biochemistry/American Association for Clinical Chemistry (NACB/AACC),
development of these guidelines was a volunteer activity. Thus the
guidelines are editorially independent from any funding body.

All potential conflicts of interest for the NACB guidelines committee
and ad hoc members of the writing committees are listed at the
following:
<http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/PublishedGuidelines/ACSHeart/heartpdf.htm>.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: 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
Jul;45(7):1104-21. \[119 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10388496)

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [National Academy of Clinical
Biochemistry (NACB) Web
site](http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/PublishedGuidelines/ACSHeart/heartpdf.htm).

Print copies: National Academy of Clinical Biochemistry publications are
available through American Association for Clinical Chemistry (AACC)
Press. To make a purchase or request a catalog, contact AACC Customer
Service at 202-857-0717 or <custserv@aacc.org>.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   Preamble. National Academy of Clinical Biochemistry laboratory
    medicine practice guidelines for utilization of biochemical markers
    in acute coronary syndromes and heart failure. Washington (DC):
    National Academy of Clinical Biochemistry (NACB); 2007. p. 1-3.

Electronic copies: Available from the [National Academy of Clinical
Biochemistry (NACB) Web
site](http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/PublishedGuidelines/ACSHeart/heartpdf.htm).

Print copies: National Academy of Clinical Biochemistry publications are
available through American Association for Clinical Chemistry (AACC)
Press. To make a purchase or request a catalog, contact AACC Customer
Service at 202-857-0717 or <custserv@aacc.org>.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI Institute on March 12, 2008. The
information was verified by the guideline developer on April 2, 2008.

#### COPYRIGHT STATEMENT

National Academy of Clinical Biochemistry\'s (NACB) terms for
reproduction of guidelines are posted with each set of guidelines.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
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Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
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Readers with questions regarding guideline content are directed to
contact the guideline developer.

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008