National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases Alan H.B. Wu, 1* Fred S. Apple, 2 W. Brian Gibler, 3 Robert L. Jesse, 4 Myron M. Warshaw, 5 and Roland Valdes, Jr. 6 The Sixth Conference on the “Standards of Laboratory Practice Series”, sponsored by the National Academy of Clinical Biochemistry (NACB), was held on August 4 –5, 1998, at the Annual Meeting of the American Associa- tion for Clinical Chemistry, in Chicago, IL. An expert committee was assembled to write recommendations on the use of cardiac markers in coronary artery diseases. The NACB Committee prepared a preliminary draft of the guidelines, made them available on the World Wide Web (www.nacb.org), and distributed them before the presentations. The recommendations were divided into four areas: the use of markers in the triage of patients with chest pain, acute coronary syndromes, clinical applications other than acute myocardial infarction and research, and assay platforms and markers of acute myocardial infarction. The recommendations were re- vised and subsequently re-presented in part at the “Biomarkers in Acute Cardiac Syndromes Conference”, sponsored by the Jewish Hospital Heart and Lung Institute, Louisville KY, on October 16 –17, 1998. This report lists each recommendation, its scientific justifica- tion, and a summary of discussions from conference participants and reviewers. Approximately 100 individuals responded to various versions of these recommendations via direct correspon- dences, telephone calls to Committee members, elec- tronic mail correspondence to the Committee Chairman, or oral questions and comments raised during one of the two conference presentations. Some of the recommen- dations were changed to reflect the consensus opinion. In cases in which there was no consensus, the Commit- tee included pertinent discussion without necessarily changing the original recommendations. At times, the 1 NACB Committee Chair, Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102. 2 Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and the University of Minnesota, Minneapolis, MN 55415. 3 Department of Emergency Medicine, University of Cincinnati, Cincin- nati, OH 45267. 4 Division of Cardiology, McGuire Veterans Administration Medical Cen- ter and the Virginia Commonwealth University/Medical College of Virginia, Richmond, VA 23225. 5 Department of Pathology, Northwest Community Hospital, Arlington Heights, IL 60005. 6 Department of Pathology and Laboratory Medicine, University of Lou- isville School of Medicine, Louisville, KY 40292. *Address correspondence to this author at: Hartford Hospital, Department of Pathology, 80 Seymour St., Hartford, CT 06102. Fax 860-545-3733; e-mail awu@harthosp.org. Received March 18, 1999; accepted May 3, 1999. Although entitled “Standards of Laboratory Practice”, the statements made in this document are “recommendations” and not practice standards. These recommendations represent the individual experiences of experts in the field of clinical biochemistry, cardiology, and emergency medicine, and should be examined for appropriateness in individual or unique settings. These recommendations were authored, in part, to provide education and guidance as to the use of these tests. Discussions contained herein may also stimulate new research studies to be conceived. Members of the discussion panels for the two meetings were as follows (alphabetically): Jesse E. Adams III, Jewish Hospital, Louisville, KY; Eugene Braunwald, Harvard Medical School, Boston, MA; Robert H. Christenson, University of Maryland, Baltimore, MD; Paul O. Collinson, Mayday University Hospital, Surrey, UK; Robert C. Hendel, North- western University, Chicago, IL; James W. Hoekstra, Ohio State University, Columbus, OH; Allan S. Jaffe, State University of New York, Syracuse, NY; Hugo A. Katus, Medizinische Universitat zu Lubeck, Lubeck, Germany; Jack H. Ladenson, Washington University, St. Louis, MO; E. Magnus Ohman, Duke University, Durham, NC; David B. Sacks, Brigham & Womens Hospital, Boston, MA; and Michael H. Salinger, Evanston Northwestern Healthcare, Evanston, IL. Mauro Panteghini, Brescia, Italy (Chair) and Francesco Dati, DiaSys Diagnostics, Holzheim, Germany (Committee member) also participated in discussions of these recommendations as members of the International Feder- ation of Clinical Chemistry Committee for the Standardization of Markers of Cardiac Damage. A list of conference participants, reviewers, and corporate sponsors will be available with the National Academy of Clinical Biochemistry monograph. Clinical Chemistry 45:7 1104 –1121 (1999) NACB 1104