Home Test Kits | Home | Contact Us | Links




C1 Esterase Inhibitor C Reactive Protein C Reactive Protein High Sensitivity CA 125 CA 153 CA 19.9 CA 27.29 Caffeine Calcitonin Calcium Calcium Ionized Carbamazepine Carbon Dioxide Carbon Monoxide Carcinoembryonic Antigen Cardiac Marker Panel Cardiovascular Risk Panel Carotene CCP Antibody CD4 Enumeration Celiac Disease Panel Centromere Antibody Cephalothin Antibody Cerebrospinal Fluid Ceruloplasmin Chemistry Panels Chlamydia Detection Chloride Cholesterol Cholinesterase Clindamycin Resistance Clostridium Difficile Coagulation Factor Assays Coagulation Factor Inhibitor Coagulation Screen Cold Agglutinin Titer Colloid Osmotic Pressure Complement Profile Complete Blood Count Congenital Adrenal Hyperplasia Cord Blood Gases Cord Blood Studies Corticotropin Releasing Hormone Stimulation Test Cortisol Cortisol in Critical Illness Cortisol Salivary Cortisol Urine Free Cortrosyn Stimulation Test Cotinine Creatine Kinase Creatine Kinase MB Creatinine Creatinine Clearance Crossmatch CRP Cryoglobulin Cryptococcal Antigen Cryptosporidium Antigen Crystal Identification Cushing Syndrome Cyclosporine Cystic Fibrosis Cytogenetic Studies Cytomegalovirus Antibody Cytomegalovirus Culture Cytomegalovirus PCR Qualitative Cytomegalovirus PCR Quantitative

Cardiac Marker Panel

Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued new guidelines for the management of patients with unstable angina and non-ST segment elevation myocardial infarction (Circulation 2000; 102:1193-1209). At the same time, a joint committee of the European Society of Cardiology and ACC published a consensus document entitled the "Redefinition of MI" (JACC 2000; 36:959-69). These articles contained the following recommendations regarding cardiac marker laboratory testing.

Troponin T or I is the preferred cardiac marker.
CK-MB is an acceptable alternative, if troponin is not available.
Total creatine kinase (CK) is no longer useful & should be discontinued.
Troponin should be measured within 6 hours of the onset of symptoms.
If the first troponin result is negative, a second sample should be obtained between 6 & 12 hours of symptom onset.
Cardiac Marker results should be available within 30 to 60 minutes.
An abnormal troponin result should be defined as >99th percentile of a normal population.
Troponin assay must have a low level of imprecision at the cutoff point (CV < 10%).

Based on these recommendations, a group of physicians from Cardiology, Emergency Medicine and Pathology at our hospital decided to implement the following changes in cardiac marker testing.

Create a new Cardiac Marker Panel for the Emergency Department that includes CK-MB & Troponin at 0, 3 & 6 hours after admission.
Retain the current Acute Cardiac Injury Panel that includes CK-MB & Troponin at 0, 6 & 12 hours for admitted patients.
Eliminate total CK from all cardiac panels.

Creation of the new Cardiac Marker Panel with shorter testing intervals facilitated more rapid decision-making in the Chest Pain Emergency Center. Retention of the 12-hour specimen for admitted patients prevented a missed diagnosis in patients who were late seroconvertors. Elimination of total CK had two major advantages. Patient charges decreased by $805,600 per year. Laboratory turnaround time was improved, because testing could be performed on one analyzer instead of two. Presently, none of the available troponin assays meets the stringent performance standard (CV < 10% at a TnI value of 2.0) specified by ACC & AHA. Therefore, the laboratory continues to test for both CK-MB and TnI.