National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure NACB WRITING GROUP MEMBERS

I. OVERVIEW OF OTHER ETIOLOGIES.....................5 A. Background and Scope..........................................5 II. USE OF CARDIAC BIOMARKERS IN THE EVALUATION OF PATIENTS WITH CHRONIC RENAL FAILURE .......................................................................7 A. Utilization of cardiac biochemical marker in the setting of chronic renal failure ............................7 1. Biomarkers in chronic renal failure....................8 III. USE OF BIOMARKERS IN THE EVALUATION OF OTHER NONISCHEMIC ETIOLOGIES ................11 A. Utilization of Cardiac Biochemical Marker in the Setting of Nonischemic Etiologies.....................11 1. Cardiac troponin and BNP/NTproBNP in other nonischemic etiologies .......................................12 2. Cardiac troponin and BNP/NTproBNP in pulmonary embolism ..............................................12 3. Cardiac troponin in critical care patients ........14 IV. USE OF BIOMARKERS AFTER NONCARDIAC SURGERY ....................................................................14 A. Use of Cardiac Biochemical Markers after Noncardiac Surgery .....................................................14 1. Biomarkers after noncardiac surgery................15 V. BIOMARKER USE AFTER PERCUTANEOUS CORONARY INTERVENTION (PCI). ............................16 A. Use of Cardiac Biochemical Markers after PCI .........................................................................16 1. Biomarkers after PCI.........................................17 VI. USE OF BIOMARKERS AFTER CARDIAC SURGERY .............................................................................18 A. Utilization of Cardiac Biochemical Markers after Cardiac Surgery ...................................................18 1 University of California at San Francisco, San Francisco, CA. 2 Mayo Clinic, Rochester, MN. 3 Hennepin County Medical Center, Minneapolis, MN. 4 Medical College of Virginia, Richmond, VA. 5 Cleveland Clinic, Cleveland, OH. 6 Harvard University, Boston, MA. 7 Duke University Medical Center, Durham, NC. 8 Aarhus University Hospital (Aalborg), Aalborg, Denmark. 9 University of Maryland School of Medicine, Baltimore, MD. * Address correspondence to this author at: University of Maryland School of Medicine, Laboratories of Pathology, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201. Fax 410-328-5880; e-mail [email protected]. The materials in this publication represent the opinions of the authors and committee members, and do not represent the official position of the NACB. The NACB is the academy of the American Association for Clinical Chemistry. Received July 29, 2007; accepted September 14, 2007. Previously published online at DOI: 10.1373/clinchem.2007.095679 © 2007 American Association for Clinical Chemistry Clinical Chemistry 53:12 2086–2096 (2007) Evidence-Based Laboratory Medicine and Test Utilization