Twerenbold R, Boeddinghaus J, Nestelberger T, et al. Clinical use of high-sensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2017;70:996-1012. 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
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
Reichlin T, Irfan A, Twerenbold R, et al. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation. 2011;124:136-145. Abstract
Haaf P, Drexler B, Reichlin T, et al. High-sensitivity cardiac troponin in the distinction of acute myocardial infarction from acute cardiac noncoronary artery disease. Circulation. 2012;126:31-40. Abstract
Mueller M, Biener M, Vafaie M, et al. Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin Chem. 2012;58:209-218. Abstract
Body R, Carley S, McDowell G, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol. 2011;58:1332-1339. Abstract
Reichlin T, Schindler C, Drexler B, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med. 2012;172:1211-1218. Abstract
Reichlin T, Twerenbold R, Wildi K, et al. Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay. CMAJ. 2015;187:E243-E252. Abstract
Mueller C, Giannitsis E, Christ M, et al. 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.e4.
Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315. Abstract
Twerenbold R, Badertscher P, Boeddinghaus J, et al. Effect of the FDA regulatory approach on the 0/1-h algorithm for rapid diagnosis of MI. J Am Coll Cardiol. 2017;70:1532-1534. Abstract
Christenson RH, ed. Laboratory medicine practice guidelines: biomarkers of acute coronary syndromes and heart failure. National Academy of Clinical Biochemistry. https://www.aacc.org/~/media/practice-guidelines/acs-and-heart-failure/acs_pdf_online.pdf?la=en. 2007. Accessed September 27, 2017.
Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Eur Heart J. 2007;28:2525-2538. Abstract
Hamm CW, Bassand JP, Agewall S, et al. 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
Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-2035. Abstract
Amsterdam EA, Wenger NK, Brindis RG, et al. 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
Neumann JT, Sörensen NA, Schwemer T, et al. Diagnosis of myocardial infarction using a high-sensitivity troponin I 1-hour algorithm. JAMA Cardiol. 2016;1:397-404. Abstract
Boeddinghaus J, Nestelberger T, Twerenbold R, et al. Direct comparison of 4 very early rule-out strategies for acute myocardial infarction using high-sensitivity cardiac troponin I. Circulation. 2017;135:1597-1611. Abstract
Thygesen K, Mair J, Giannitsis E, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J. 2012;33:2252-2257. Abstract
Twerenbold R, Wildi K, Jaeger C, et al. Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction. Circulation. 2015;131:2041-2050. Abstract
Korley FK, Jaffe AS. High sensitivity cardiac troponin assays - how to implement them successfully. EJIFCC. 2016;27:217-223. Abstract
Galli C, Lippi G. High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages. Ann Transl Med. 2016;4:257.
Twerenbold R, Jaeger C, Rubini Gimenez M, et al. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction. Eur Heart J. 2016;37:3324-3332. Abstract
Melki D, Lugnegård J, Alfredsson J, et al. Implications of introducing high-sensitivity cardiac troponin T into clinical practice: data from the SWEDEHEART registry. J Am Coll Cardiol. 2015;65:1655-1664. Abstract
510(k) substantial equivalence determination decision summary assay only template. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/cdrh_docs/reviews/K162895.pdf. Accessed September 27, 2017.

CME / ABIM MOC / CE

Diagnostic Algorithms for ACS and High-Sensitivity Troponin: Where Are We Today?

Authors: David A. Morrow, MD, MPH; Christian E. Mueller, MD; Evangelos Giannitsis, MD
CME / ABIM MOC / CE Released: 12/6/2017
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 12/6/2019, 11:59 PM EST

Target Audience and Goal Statement

This activity is intended for cardiologists, emergency medicine physicians, primary care physicians, nurses, and all clinicians interested in newly available hs-cTn assays.

The goal of this activity is to improve clinicians' understanding of high-sensitivity troponin and its application in clinical practice.

Upon completion of this activity, participants will:

Have increased knowledge regarding the
- Evidence-based diagnostic algorithms for acute coronary syndrome (ACS)
- Role of high-sensitivity troponin assays in the diagnosis of ACS
Have greater competence related to
- Use of multidisciplinary strategies to incorporate the latest ACS diagnostic algorithms into clinical care

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

David A. Morrow, MD, MPH

Director of the Biomarker Program, TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts, United States

Disclosures

Disclosure: David A. Morrow, MD, MPH, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Aralez Pharmaceuticals Inc.; Bayer HealthCare Pharmaceuticals; GlaxoSmithKline; Merck & Co., Inc.; Peloton Therapeutics, Inc.; Roche; Verseon Corporation
Served as a speaker or a member of a speakers bureau for: Roche Diagnostics
Received grants for clinical research from: Abbott Laboratories; Amgen Inc.; AstraZeneca Pharmaceuticals LP; Daiichi Sankyo, Inc.; Eisai Inc.; GlaxoSmithKline; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc; Roche Diagnostics; Takeda Pharmaceuticals North America, Inc.

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

Panelists

Christian E. Mueller, MD

Professor of Cardiology; Director, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland

Disclosures

Disclosure: Christian Mueller, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Actelion Pharmaceuticals, Ltd; Alere; Amgen Inc.; AstraZeneca Pharmaceuticals LP; bioMérieux SA; Boehringer Ingelheim Pharmaceuticals, Inc.; Brahms; Bristol-Myers Squibb Company; Cardiorentis AG; Novartis Pharmaceuticals Corporation; Roche; Sanofi; Siemens AG; Singulex
Served as a speaker or a member of a speakers bureau for: Abbott Laboratories; Actelion Pharmaceuticals, Ltd; Alere; Amgen Inc.; AstraZeneca Pharmaceuticals LP; bioMérieux SA; Boehringer Ingelheim Pharmaceuticals, Inc.; Brahms; Bristol-Myers Squibb Company; Cardiorentis AG; Novartis Pharmaceuticals Corporation; Roche; Sanofi; Siemens AG; Singulex
Received grants for clinical research from: Abbott Laboratories; Beckman Coulter, Inc.; bioMérieux SA; Brahms; Ortho Clinical Diagnostics; Roche; Siemens AG; Singulex; sphingotec GmbH

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

Evangelos Giannitsis, MD

Professor, University of Heidelberg, Heidelberg, Germany

Disclosures

Disclosure: Evangelos Giannitsis, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Roche Diagnostics
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Bayer Vital GmbH; Daiichi Sankyo, Inc.; Roche Diagnostics
Received grants for clinical research from: Bayer Vital GmbH

Dr Giannitsis 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 Giannitsis 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

Professor of Medicine, Division of Cardiology, 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; Roche; Siemens AG
Received grants for clinical research from: Novartis Pharmaceuticals Corporation; Prevencio, Inc.; Roche; Singulex

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

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; Roche; Samsung; Siemens Healthcare

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

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.

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

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For Physicians

Medscape, LLC designates this enduring material for a maximum of 0.75 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 0.75 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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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 75% 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 / ABIM MOC / CE

Diagnostic Algorithms for ACS and High-Sensitivity Troponin: Where Are We Today?

Authors: David A. Morrow, MD, MPH; Christian E. Mueller, MD; Evangelos Giannitsis, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 12/6/2017

Valid for credit through: 12/6/2019, 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

Moderator

David A. Morrow, MD, MPH

Panelists

Christian E. Mueller, MD

Evangelos Giannitsis, MD

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

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

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

CME / ABIM MOC / CE

Diagnostic Algorithms for ACS and High-Sensitivity Troponin: Where Are We Today?

Target Audience and Goal Statement

Disclosures

Moderator

David A. Morrow, MD, MPH

Panelists

Christian E. Mueller, MD

Evangelos Giannitsis, MD

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

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

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

Diagnostic Algorithms for ACS and High-Sensitivity Troponin: Where Are We Today?

Expert Commentary