Centers for Disease Control. National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf Accessed April 17, 2016.
Amsterdam EA, Wenger NK, Brindis RG, et al; ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344-e426. Abstract
de Lemos JA. Increasingly sensitive assays for cardiac troponins: a review. JAMA. 2013;309:2262-2269. Abstract
Xu RY, Zhu XF, Yang Y, et al. High-sensitive cardiac troponin T. J Geriatr Cardiol. 2013;10:102-109. Abstract
Thygesen K, Alpert JS, Jaffe AS, et al; Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-2035. Abstract
Palamalai V, Murakami MM, Apple FS. Diagnostic performance of four point of care cardiac troponin I assays to rule in and rule out acute myocardial infarction. Clin Biochem. 2013;46:1631-1635. Abstract
Sandoval Y, Apple FS. The global need to define normality: the 99th percentile value of cardiac troponin. Clin Chem. 2014;60:455-462. Abstract
Gore MO, Seliger SL, Defilippi CR, et al. Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J Am Coll Cardiol. 2014;63:1441-1448. Abstract
Keller T, Münzel T, Blankenberg S. Making it more sensitive: the new era of troponin use. Circulation. 2011;123:1361-1363. Abstract
Bonaca M, Scirica B, Sabatine M, et al. Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I. J Am Coll Cardiol. 2010;55:2118-2124. Abstract
Carlton EW, Cullen L, Than M, et al. A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin. Heart. 2015;101:1041-1046. Abstract
de Lemos JA, Drazner MH, Omland T, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010;304:2503-2512. Abstract
Everett BM, Cook NR, Magnone MC, et al. Sensitive cardiac troponin T assay and the risk of incident cardiovascular disease in women with and without diabetes mellitus: the Women's Health Study. Circulation. 2011;123:2811-2818. Abstract
deFilippi CR, de Lemos JA, Christenson RH, et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010;304:2494-2502. Abstract
Saunders JT, Nambi V, de Lemos JA, et al. Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation. 2011;123:1367-1376. Abstract
Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8:195-203. Abstract

CME / CE

Cardiac Troponin: Defining the 99th percentile reference limit for MI

Authors: Akshay S. Desai, MD, MPH; Alan B. Storrow, MD; Dina N. Greene, PhD
CME / CE Released: 5/3/2016
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 5/3/2017, 11:59 PM EST

Target Audience and Goal Statement

This activity is intended for cardiologists, emergency medicine physicians, nurses, and primary care physicians interested in the care of patients with acute coronary syndrome (ACS).

The goal of this activity is to increase awareness of cardiac troponin testing, its convenience, and, especially, the appropriate interpretation of abnormal values.

Upon completion of this activity, participants will be able to:

Recognize troponin as a marker of cardiac injury
Assess cardiac troponin(cTn) testing, utility, and appropriate interpretation of abnormal values

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Akshay S. Desai, MD, MPH

Associate Professor of Medicine, Harvard Medical School; Director, Heart Failure Disease Management Program, Brigham and Women's Hospital, Boston, Massachusetts

Disclosures

Disclosure: Akshay S. Desai, MD, MPH, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Relypsa, Inc.; St. Jude Medical
Served as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals Corporation; St. Jude Medical

Dr Desai does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Desai does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Alan B. Storrow, MD

Emergency Medicine Consultant, Nashville, Tennessee

Disclosures

Disclosure: Alan B. Storrow, MD, has disclosed the following relevant financial relationships:
Served on the data safety monitoring board for: Trevena, Inc.

Dr Storrow does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Storrow does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Dina N. Greene, PhD

Assistant Professor, Department of Laboratory Medicine, University of Washington, Seattle, Washington

Disclosures

Disclosure: Dina N. Greene, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Roche

Dr Greene does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.
Dr Greene does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Steering Committee

James L. Januzzi, MD (Chair)

Hutter Family Professor of Medicine, Division of Cardiology, Harvard Medical School; Roman W. DeSanctis Endowed Clinical Scholar, Massachusetts General Hospital, Boston, Massachusetts

Disclosures

Disclosure: James L. Januzzi, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; Critical Diagnostics; Novartis Pharmaceuticals Corporation; Philips Healthcare; Roche; sphingotec, LLC
Received grants for clinical research from: Prevencio, Inc.; Siemens AG; Singulex

Michael Felker, MD

Professor of Medicine, Duke University, Durham, North Carolina

Disclosures

Disclosure: Michael Felker, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; Bristol-Myers Squibb Company; Novartis Pharmaceuticals Corporation; Trevena, Inc.
Received grants for clinical research from: Amgen Inc.; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Otsuka Pharmaceutical Co., Ltd.; Roche

Allan S. Jaffe, MD

Professor of Medicine, Mayo Medical School; Chair, Core Clinical Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota

Disclosures

Disclosure: Allan S. Jaffe, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Alere; Beckman Coulter, Inc.; Dart NeuroScience LLC; diaDexus, Inc.; ET Healthcare, Inc.; Lpath Incorporated; Novartis Pharmaceuticals Corporation; Radiometer Medical ApS; Roche; Siemens AG; Trinity Pharma Solutions

David A. Morrow, MD, MPH

Associate Professor of Medicine, Harvard Medical School; Director, Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, Massachusetts

Disclosures

Disclosure: David A. Morrow, MD, MPH, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Diagnostics; AstraZeneca Pharmaceuticals LP; diaDexus, Inc.; GlaxoSmithKline; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Roche
Received grants for clinical research from: Abbott Diagnostics; Amgen Inc.; AstraZeneca Pharmaceuticals LP; Beckman Coulter, Inc.; BG Medicine; Daiichi Sankyo, Inc.; Eisai Inc.; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Ortho-Clinical Diagnostics, Inc.; Randox Laboratories Ltd.; Roche; Singulex

Ileana L. Piña, MD, MPH

Professor of Medicine and Epidemiology and Population Health; Associate Chief, Academic Affairs, Albert Einstein College of Medicine / Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York

Disclosures

Disclosure: Ileana L. Piña, MD, MPH, has disclosed no relevant financial relationships.

W. Brian Gibler, MD

Professor of Emergency Medicine; Director of Business Development, University of Cincinnati College of Medicine, Cincinnati, Ohio

Disclosures

Disclosure: W. Brian Gibler, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Entegrion, Inc.; Intelemage®, LLC; Roche
Owns stock, stock options, or bonds from: Entegrion, Inc.; Intelemage, LLC; MyoCardioCare, Inc.; Siloam

L. Kristin Newby, MD, MHS

Professor of Medicine, Cardiology, Duke University School of Medicine; Co-Director, Duke Cardiac Care Unit, Duke University Medical Center, Durham, North Carolina

Disclosures

Disclosure: L. Kristin Newby, MD, MHS, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; BASF Corporation; BioKier, Inc.; Bristol-Myers Squibb Company; CardioDx, Inc.; DemeRx, Inc.; Merck & Co., Inc.; metanomics GmbH; Philips Healthcare; Roche
Received grants for clinical research from: Bristol-Myers Squibb Company; GlaxoSmithKline

Editors

Joy P. Marko, MS, APN-C, CCMEP

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Joy P. Marko, MS, APN-C, CCMEP, has disclosed no relevant financial relationships.

Kalanethee Paul-Pletzer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Kalanethee Paul-Pletzer, PhD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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Awarded 0.50 contact hour(s) of continuing nursing education for RNs and APNs; 0 contact hours are in the area of pharmacology.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

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From Medscape Education Cardiology

CME / CE

Cardiac Troponin: Defining the 99th percentile reference limit for MI

Authors: Akshay S. Desai, MD, MPH; Alan B. Storrow, MD; Dina N. Greene, PhDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 5/3/2016

Valid for credit through: 5/3/2017, 11:59 PM EST

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The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Author(s)

Akshay S. Desai, MD, MPH

Alan B. Storrow, MD

Dina N. Greene, PhD

Steering Committee

James L. Januzzi, MD (Chair)

Michael Felker, MD

Allan S. Jaffe, MD

David A. Morrow, MD, MPH

Ileana L. Piña, MD, MPH

W. Brian Gibler, MD

L. Kristin Newby, MD, MHS

Editors

Joy P. Marko, MS, APN-C, CCMEP

Kalanethee Paul-Pletzer, PhD

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

CME / CE

Cardiac Troponin: Defining the 99th percentile reference limit for MI

Target Audience and Goal Statement

Disclosures

Author(s)

Akshay S. Desai, MD, MPH

Alan B. Storrow, MD

Dina N. Greene, PhD

Steering Committee

James L. Januzzi, MD (Chair)

Michael Felker, MD

Allan S. Jaffe, MD

David A. Morrow, MD, MPH

Ileana L. Piña, MD, MPH

W. Brian Gibler, MD

L. Kristin Newby, MD, MHS

Editors

Joy P. Marko, MS, APN-C, CCMEP

Kalanethee Paul-Pletzer, PhD

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

Cardiac Troponin: Defining the 99th percentile reference limit for MI