THE CARDIAC PROFILE AND PROPOSED PRACTICE GUIDELINE FOR ACUTE ISCHEMIC-HEART-DISEASE

Presented with an ever-increasing array of potential tests of myocardi al injury, the clinical pathologist in conjunction with physicians in primary care, cardiology, and other clinical disciplines must evolve a practical approach for each individual institution. This involves ide ntifying the tests available for immediate (stat) or timed performance , the appropriate patients for whom testing is desired, the schedule o f frequency and duration of testing, and the manner in which the test results are to be interpreted. A guideline is presented to address the se issues with the purpose of stimulating local adoption of an appropr iately modified version to accommodate the current state of the art. S elective choice of an early marker, creatine kinase MB by mass immunoa ssay, in conjunction with cardiac troponin I (cTnI), is proposed as th e appropriate combination of laboratory tests that emphasizes the card iospecificity of cTnI for the variety of applications in which the ''c ardiac profile'' formerly has been used, including the spectrum of cli nical settings in which suspected myocardial infarction must be consid ered. A rationale is provided with emphasis on the relative merit of t he various biochemical markers in contrast with other modalities for e valuating suspected myocardial injury.