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1. All patients with ACS symptoms should be tested for biochemical markers of myocardial necrosis. (Level of evidence: C)
2. In the process of diagnosis and evaluation of patients with suspected MI, clinical manifestations (history and physical examination), ECG and biochemical markers should be considered together. (Level of evidence: C)
3. Cardiac troponin is the preferred marker for the diagnosis of MI. When there is no condition to detect cardiac troponin, creatine kinase MB (CK-MB) quality analysis is an acceptable alternative method. (Level of evidence: A)
4. Blood should be collected and tested when the patient arrives at the hospital, followed by continuous sampling and monitoring based on the patient's clinical condition. For most patients, blood tests should be taken immediately and at 6-9 hours. (Level of evidence: C)
5. If the clinical history indicates that the patient has ACS, the following conditions should be considered as myocardial necrosis showing MI. (Level of evidence: C)
(1) Within the first 24 hours after the clinical event occurs, the maximum concentration of cardiac troponin exceeds the 99th percentile of the normal reference population value at least once (total coefficient of variation (CV) <10% is defined as Optimal precision) (observing the increase and / or decrease of the value helps to determine the time of myocardial damage).
(2) In the results of two consecutive blood collection tests, the maximum concentration of CK-MB exceeds the 99th percentile of the normal reference population value of a specific gender (the value of CK-MB should increase and / or decrease).
Class â…¡B
1. For patients within 6 hours after the onset of symptoms, in addition to cardiac troponin, early myocardial necrosis markers can also be considered. Myoglobin is the most widely studied marker for this purpose. (Level of evidence: B)
2. In order to formulate a treatment plan, it is appropriate to adopt a rapid screening method to detect myocardial necrosis markers by multiple early blood collections. (Level of evidence: C)
Class III
1. Total CK, CK-MB activity analysis, aspartate aminotransferase (AST, SGOT), β-hydroxybutyrate dehydrogenase and lactate dehydrogenase should not be used as biochemical markers for the diagnosis of MI. (Level of evidence: C)
2. If the patient's ECG is abnormal (such as a new ST segment elevation) at the time of the doctor's visit, he should not wait for the results of biochemical markers to avoid delaying diagnosis and treatment. (Level of evidence: C)
B. Early risk stratification Recommendations on the use of biochemical markers for early risk stratification of ACS
Class I
1. Early risk stratification of patients with suspected ACS should be based on a comprehensive evaluation of symptoms, physical examination, ECG, and biochemical marker levels. (Level of evidence: C)
2. Cardiac troponin is the biochemical marker of choice for risk stratification. If possible, all suspected ACS patients should be tested. For patients with clinical symptoms of ACS, if the maximum concentration (peak) of cardiac troponin exceeds the 99th percentile of the normal reference population value, it means an increased risk of death and recurrent ischemic events. (Level of evidence: A)
3. Blood should be collected and tested when the patient arrives at the hospital, and then sampling and monitoring should be performed continuously and regularly according to the clinical condition. For most patients, blood tests should be taken immediately and at 6-9 hours. (Level of evidence: B)
Class â…¡A
1. In the risk assessment of patients with clinical symptoms of ACS, in addition to cardiac troponin, the detection of high-sensitivity C-reactive protein (hs-CRP) may be helpful, but the value of treatment based on this strategy has not been determined. (Level of evidence: A)
2. In the risk assessment of patients with clinical symptoms of ACS, in addition to cardiac troponin, it may be helpful to detect brain type (B) natriuretic peptide (BNP) or N-terminal forebrain natriuretic peptide (NT-proBNP) of. However, the value of treatment based on this strategy has not yet been determined. (Level of evidence: A)
Class IIB
1. For patients with clinically less likely myocardial ischemia, in addition to cardiac troponin and ECG, detection of myocardial ischemic markers can help rule out ACS. (Level of evidence: C)
2. For patients with clinical symptoms of ACS, in addition to cardiac troponin, a variety of marker strategies, including the detection of two or more pathologically different biochemical markers, can help enhance risk stratification. BNP and hs-CRP are the most sufficient biochemical markers for this method, but the value of treatment based on this strategy has not yet been determined. (Level of evidence: C)
3. For the treatment strategy, early repeated blood collection (such as 2 to 4 hours after the visit) is appropriate to detect cardiac troponin. (Level of evidence: C)
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