Cardiac markers guidelines

Several guidelines, standards and recommendations are relevant for specific users of the AQT90 FLEX analyser

Use of troponin and/or CKMB

2007 consensus report on acute myocardial infarction definition made by a task force on behalf of ESC (European Society of Cardiology), ACCF (American College of Cardiology Foundation), AHA (American Heart Association) and WHF World Heart Federation).

In the new definition the use of cardiac biomarkers, preferably troponin, is still central in the diagnosis of myocardial infarction, together with ECG and patient history. An elevation of troponin (or another cardiac biomarker) combined with at least one of the following: ECG changes, imaging evidence or ischemia symptoms meet the criteria for a diagnosis of myocardial infarction:

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.187397

Use of cardiac markers in the Emergency Department

Review piece including guidelines and recommendations on current cardiac markers in acute coronary syndrome and their role in therapeutic decisions, the best marker strategy, point-of-care assays and troponin cut-off values.

http://emedicine.medscape.com/article/811905-overview

FDA on Troponin: What laboratorians should know to manage elevated results

The FDA document gives a good overview of potential causes for falsely elevated troponin values and lists some clinical conditions associated with truly elevated levels of cardiac troponin in the absence of myocardial infarction.

The document can be accessed here:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ TipsandArticlesonDeviceSafety/ucm109362.htm

Use of D-dimer

The British Thoracic Society has guidelines for the use of a D-dimer test in patients suspected pulmonary embolism:

http://www.brit-thoracic.org.uk/clinical-information/pulmonary-embolism/pulmonary-embolism-guidelines.aspx

The American Academy of Family Physicians and the American College of Physicians has a guideline for the diagnosis of venous thromboembolism:

http://www.annfammed.org/cgi/content/full/5/1/57

Use of BNP and/or NT-proBNP

2008 Guidelines for the diagnosis and treatment of heart failure made by a task force on behalf of ESC (European Society of Cardiology), the Heart Failure Association of the ESC (HFA) and indorsed by the European Society of Intensive Care Medicine (ESICM).

In addition, a comprehensive heart failure practice guideline was approved by the Heart Failure Society of America (HFSA) Executive Council in June 2010.

The natriuretic peptides (BNP and NT-proBNP) are especially useful in the diagnosis of heart failure.

http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-HF-FT.pdf

http://www.heartfailureguideline.org/home/3

The International NT-proBNP Consensus Panel has made a formal up-to-date and unbiased consensus statement after reviewing the current understanding of the biologic, analytic, and clinical applications of NT-proBNP. The document can be downloaded here:

http://www.365heart.com/zt/luoshi/ International_consensus_complete_2008.pdf

Use of CRP

2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults, written by the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) Task Force on Practice Guidelines in collaboration with six other specialty societies can be found here:

http://circ.ahajournals.org/cgi/reprint/122/25/e584

In the Emergency Department

American College of Emergency Physicians provides a guideline for Emergency Department planning and resources:

The medical director of the ED and the director of laboratory services should develop guidelines for availability and timeliness of services for an individual hospital's ED.

American College of Emergency Physicians, (click to download)