National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes.

I. OVERVIEW OF THE ACUTE CORONARY SYNDROME ............................................................e357 A. Definition of Terms............................................e357 B. Pathogenesis and Management of ACS.............e357 II. USE OF BIOCHEMICAL MARKERS IN THE INITIAL EVALUATION OF ACS .........................e358 A. Diagnosis of Myocardial Infarction ...................e358 1. Biochemical Markers of Myocardial Necrosis .........................................................e358 2. Optimal Timing of Sample Acquisition.......e359 3. Criteria for Diagnosis of MI.........................e360 4. Additional Considerations in the Use of Biomarkers for Diagnosis of MI ..................e360 B. Early Risk Stratification .....................................e361 1. Biochemical Markers of Cardiac Injury.......e361 a. Pathophysiology.......................................e361 b. Relationship to Clinical Outcomes .........e361 c. Decision-Limits .......................................e362 d. Therapeutic Decision-Making .................e362 2. Natriuretic Peptides.......................................e362 a. Pathophysiology.......................................e362 b. Relationship to Clinical Outcomes .........e363 c. Decision-Limits .......................................e364 d. Therapeutic Decision-Making .................e365 3. Biochemical Markers of Inflammation ........e365 a. Pathophysiology.......................................e365 b. Relationship to Clinical Outcomes .........e365 c. Decision-Limits .......................................e365 d. Therapeutic Decision-Making .................e367 4. Biochemical Markers of Ischemia................e367 5. Multimarker Approach..................................e367 6. Other Novel Markers ....................................e368 III. USE OF BIOCHEMICAL MARKERS IN THE MANAGEMENT OF NSTEACS ............................e368 A. Clinical Decision-Making...................................e368 1. Biochemical Markers of Cardiac Injury.......e368 2. Other Biochemical Markers..........................e369