American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction

In its report in 2002, the American College of Cardiology/American Heart Association Task Force updated its guidelines for the Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction. The guidelines have made several recommendations regarding the use of biomarkers of cardiac injury in all patients who present in the emergency department with chest discomfort. The report from the task force recommendsthe following:

• The use of biomarkers of cardiac injury should be included in the early stages of risk stratification for emergency department patients with chest discomfort.
• A combination of an early marker of cardiac injury with cardiac-specific troponin should be considered for patients who present within six hours of the onset of the sypmtoms.
• The guidelines recommend a turnaround time for central laboratory testing of cardiac markers to be available within 60 minutes, preferably 30 minutes.
• The availability of point-of-care testing devices that are capable of testing myoglobin, CK-MB and troponin I simultaneously are likely to be useful in the diagnosis of acute coronary syndromes patients.

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National Academy of Clinical Biochemistry (NACB) Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Disease

In 1999, NACB published a set of guidelines for the use of cardiac markers in coronary artery diseases. Serial monitoring of biochemical markers is recommended in the early triage period to ascertain dynamic changes which could respond to definitive treatment. Additionally, the following practices were recommended:

• Emergency department phsyicians, cardiologists, and clinical laboratorians should work together to develop an “accelerated protocol for the use of biochemical markers in the evaluation of patients with possible acute coronary syndromes.”
• Measurement of a combination of an early cardiac marker that rises within six hours after onset of symptoms and a definitive marker which is cardio-specific and sensitive to myocardial injury.
• The target turnaround time for laboratory cardiac marker testing should be less than an hour. If the laboratory cannot consistently deliver results within the targeted time frame, hospitals should consider implementing point-of-care testing.

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