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NACB Guidelines for the Use of Serum Cardiac Markers
Guidelines established by the National Academy of Clinical Biochemistry (NACB)3 state:
1. Members of emergency departments, divisions of cardiology, hospital administrations and clinical laboratories should work collectively to develop an accelerated protocol for use of biochemical markers for the evaluation of patients with possible acute coronary syndromes.
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The laboratory should perform STAT cardiac marker testing on a continuous random-access basis, with a target turnaround time (TAT) of one hour or less. The TAT is defined as the time from blood collection to the reporting of results. |
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Institutions that cannot consistently deliver cardiac marker TATs of approximately one hour should implement Point-of-Care (POC) testing devices. The cutoff concentrations of these devices should be set at the 97.5% upper reference limits so that the devices can detect the first presence of true myocardial injury. |
2. Two biochemical markers should be used for routine AMI diagnosis: an early marker (reliably increased in blood within 6 h after onset of symptoms) and a definitive marker (increased after 6-9 h, but has high sensitivity and specificity for myocardial injury, remaining abnormal for several days after onset).
3. Assays for cardiac markers should have an imprecision (CV) < 10% at the AMI decisions limit and an assay TAT of < 30 min.
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Myoglobin is the marker that most effectively fits the role as an early marker. A rise in Myoglobin is detectable in blood as early as 1-2 h after onset and can be highly effective for AMI rule-out. |
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Cardiac Troponin (T or I) is the new standard for diagnosis of myocardial infarction and detection of myocardial cell damage, replacing CK-MB. Troponins appear in the serum relatively early after the onset of symptoms (4-12 h) and remain abnormal for 4-10 days. |
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Two decision limits are needed for the optimum use of sensitive and specific cardiac markers, such as Cardiac Troponin I or Troponin T. A low abnormal value establishes the first presence of true myocardial injury, and a higher value is suggestive of injury to the extent that it qualifies as AMI. |
View more about the latest practice guidelines:
ESC/ACC
ACC/AHA
NACB
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