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

Preamble 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 19991. 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. These guidelines were developed utilizing best available evidence, and they incorporated substantial input from