Apple FS, Jaffe AS, Collinson P, et al; International Federation of Clinical Chemistry (IFCC) Task Force on Clinical Applications of Cardiac Bio-Markers. IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem. 2015;48:201-203. Abstract
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
4.Giannitsis E, Kurz K, Hallermayer K, et al. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:254-261. 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
Thygesen K, Mair J, Giannitsis E, et al; Study Group on Biomarkers in Cardiology of ESC Working Group on Acute Cardiac Care. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J. 2012;33:2252-2257. Abstract
Reichlin T, Hochholzer W, Bassetti S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361:858-867. Abstract
Elecsys Troponin T Gen 5 STAT [package insert]. Indianapolis, IN: Roche Diagnostics; 2017.
Chenevier-Gobeaux C, Bonnefoy-Cudraz É, Charpentier S, et al; SFBC, SFC, SFMU 'Troponins' Workgroup. High-sensitivity cardiac troponin assays: answers to frequently asked questions. Arch Cardiovasc Dis. 2015;108:132-149. Abstract
Than M, Cullen L, Reid CM, et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet. 2011;377:1077-1084. Abstract
Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012;59:2091-2098. Abstract
Cullen L, Mueller C, Parsonage WA, et al. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol. 2013;62:1242-1249. Abstract
Mueller C, Giannitsis E, Christ M, et al; TRAPID-AMI Investigators. Multicenter evaluation of a 0-Hour/1-Hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emerg Med. 2016;68:76-87. Abstract
The National Academy of Clinical Biochemistry. Laboratory Medicine Practice Guidelines: Biomarkers of Acute Coronary Syndromes and Heart Failure. https://www.aacc.org/~/media/practice-guidelines/acs-and-heart-failure/acs_pdf_online.pdf?la=en. Accessed March, 2017.
Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J. 2007;28:2525-2538. Abstract
Hamm CW, Bassand JP, Agewall S, et al; ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999-3054. Abstract
Garg P, Morris P, Fazlanie AL, et al. Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin. Intern Emerg Med. 2017;12:147-155. Abstract
Peacock WF 4th, De Marco T, Fonarow GC, et al; ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358:2117-2126. Abstract
Singer AJ, Than MP, Smith S, et al. Missed myocardial infarctions in ED patients prospectively categorized as low risk by established risk scores. Am J Emerg Med. 2017 [Epub ahead of print].
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CME / ABIM MOC / CE

Part I – A Sensible Approach to Sensitive Troponin

Authors: James L. Januzzi, MD; W. Frank Peacock, MD; and Robert H. Christenson, PhD
CME / ABIM MOC / CE Released: 4/17/2017
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 4/17/2019, 11:59 PM EST

Target Audience and Goal Statement

This activity is intended for cardiologists, emergency medicine physicians, primary care physicians, and nurses.

The goal of this activity is to provide clinicians with foundational knowledge regarding high-sensitivity cardiac troponin and its utilization for the diagnosis of myocardial infarction.

Upon completion of this activity, participants will:

Have increased knowledge regarding the latest data on high sensitivity troponin as a biomarker in the setting of MI
Have increased knowledge regarding the approved applications of high-sensitivity troponin
Have greater competence related to their ability to incorporate high-sensitivity troponin into clinical practice to improve diagnosis of MI

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.

Moderator

James L. Januzzi, MD

Hutter Family Professor of Medicine, Harvard Medical School, 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: Abbott Laboratories; Critical Diagnostics; Roche; Siemens AG
Received grants for clinical research from: Novartis Pharmaceuticals Corporation; Prevencio, Inc.; Roche; Singulex

Dr Januzzi does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

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

Panelist

W. Frank Peacock, MD

Professor, Department of Emergency Medicine, Associate Chair and Research Director, Baylor College of Medicine, Houston, Texas

Disclosures

Disclosure: W. Frank Peacock, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer Healthcare; Beckman Coulter, Inc.; Instrumentation Laboratory; Janssen Pharmaceuticals; Relypsa, Inc.; Roche; ZS Pharma
Received grants for clinical research from: Abbott Laboratories; Janssen Pharmaceuticals; Roche; ZS Pharma
Owns stock, stock options, or bonds from: Ischemia Care

Dr Peacock does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

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

Robert H. Christenson, PhD

Professor of Pathology, Professor of Medical and Research Technology, University of Maryland School of Medicine, Baltimore, Maryland

Disclosures

Disclosure: Robert H. Christenson, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Becton Dickinson and Company; Roche; Siemens Healthcare
Served as a speaker or a member of a speakers bureau for: Roche; Siemens Healthcare
Received grants for clinical research from: Abbott Laboratories; Alere; Banyan Biomarkers; Fujirebio Diagnostics, Inc.; Mitsubishi Chemical; Ortho Clinical Diagnostics; Roche; Samsung; Siemens Healthcare

Dr Christenson 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 Christenson 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

Disclosures

Disclosure: As listed above.

Javed Butler, MD, MBA, MPH

Professor of Medicine; Professor of Physiology and Biophysics; Director, Division of Cardiology; Co-Director, Heart Institute, Stony Brook University, Stony Brook, New York

Disclosures

Disclosure: Javed Butler, MD, MBA, MPH has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; AstraZeneca; Bayer HealthCare; CardioCell, LLC; CVRx, Inc.; Janssen Pharmaceuticals; Luitpold Pharmaceuticals; Medtronic, Inc.; Novartis Pharmaceuticals Corporation; Relypsa, Inc.; ZS Pharma
Served as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals Corporation

Robert H. Christenson, PhD

Disclosures

Disclosure: As listed above.

Lori B. Daniels, MD, MAS

Professor of Medicine, University of California, San Diego, La Jolla, California

Disclosures

Disclosure: Lori B. Daniels, MD, MAS has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Critical Diagnostics; Janssen Pharmaceuticals; Roche
Other: Independent contractor, Siemens

Peter S. Pang, MD

Associate Professor of Emergency Medicine, Indiana University School of Medicine; Chief Science Officer, Indianapolis EMS, Indianapolis, Indiana

Disclosures

Disclosure: Peter S. Pang, MD has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bristol-Myers Squibb Company; Novartis Pharmaceuticals Corporation; Relypsa, Inc.; Roche; scPharmaceuticals; Trevena Inc.
Received grants for clinical research from: Novartis Pharmaceuticals Corporation; Roche

Editor(s)

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.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott; HeartWare International, Inc; Medtronic Inc; Thoratec Corporation

Accreditation Statements

In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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For Nurses

Awarded 0.5 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]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

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.

Follow these steps to earn CME/CE credit*:

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Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

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 / ABIM MOC / CE

Part I – A Sensible Approach to Sensitive Troponin

Authors: James L. Januzzi, MD; W. Frank Peacock, MD; and Robert H. Christenson, PhDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 4/17/2017

Valid for credit through: 4/17/2019, 11:59 PM EST

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Disclaimer

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

Moderator

James L. Januzzi, MD

Panelist

W. Frank Peacock, MD

Robert H. Christenson, PhD

Steering Committee

James L. Januzzi, MD

Javed Butler, MD, MBA, MPH

Robert H. Christenson, PhD

Lori B. Daniels, MD, MAS

Peter S. Pang, MD

Editor(s)

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

Kalanethee Paul-Pletzer, PhD

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

CME / ABIM MOC / CE

Part I – A Sensible Approach to Sensitive Troponin

Target Audience and Goal Statement

Disclosures

Moderator

James L. Januzzi, MD

Panelist

W. Frank Peacock, MD

Robert H. Christenson, PhD

Steering Committee

James L. Januzzi, MD

Javed Butler, MD, MBA, MPH

Robert H. Christenson, PhD

Lori B. Daniels, MD, MAS

Peter S. Pang, MD

Editor(s)

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

Kalanethee Paul-Pletzer, PhD

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

Part I – A Sensible Approach to Sensitive Troponin