Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Non–ST-Segment Elevation Acute Coronary Syndromes  Francis M. Fesmire, MD (Subcommittee Chair), Wyatt W. Decker, MD, Deborah B. Diercks, MD, Chris A. Ghaemmaghami, MD, Devorah Nazarian, MD, William J. Brady, MD, Sigrid Hahn, MD, Andy S. Jagoda, MD (Clinical Policies Committee Chair)  Annals of Emergency Medicine  Volume 48, Issue 3, Pages 270-301 (September 2006) DOI: 10.1016/j.annemergmed.2006.07.005 Copyright © 2006 American College of Emergency Physicians Terms and Conditions

Figure 1 WHO diagnostic criteria for acute myocardial infarction. Annals of Emergency Medicine 2006 48, 270-301DOI: (10.1016/j.annemergmed.2006.07.005) Copyright © 2006 American College of Emergency Physicians Terms and Conditions

Figure 2 ESC/ACC diagnostic criteria for acute myocardial infarction. Annals of Emergency Medicine 2006 48, 270-301DOI: (10.1016/j.annemergmed.2006.07.005) Copyright © 2006 American College of Emergency Physicians Terms and Conditions

Figure 3 Timing of release of common cardiac markers of necrosis. Peaks A, B, and C respectively demonstrate release of myoglobin, troponin, and CK-MB in acute myocardial infarction as defined by WHO diagnostic criteria. Peak D demonstrates troponin release in troponin positive/CK-MB negative acute coronary syndrome now defined as acute myocardial infarction by ESC/ACC diagnostic criteria. Modified from Wu AHB, Apple FS, Gibler WB, et al. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery disease. Clin Chem. 1999;45:1104-1121. Reprinted with permission. Annals of Emergency Medicine 2006 48, 270-301DOI: (10.1016/j.annemergmed.2006.07.005) Copyright © 2006 American College of Emergency Physicians Terms and Conditions