Chronic stable angina laboratory findings: Difference between revisions

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(/* ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT){{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the mana...)
(/* ESC Guidelines- Blood tests for routine reassessment in patients with chronic stable angina (DO NOT EDIT){{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable ang...)
 
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==Overview==
==Overview==
In patients with chronic stable angina, initial laboratory investigations are used to: '''identify potential causes''' of [[ischemia]], '''establish risk factors''', and '''determine the overall prognosis for the patient'''. An initial laboratory test can provide a wide variety of clinical information. For instance, low hemoglobin levels can cause ischemia. Therefore, assessing hemoglobin as a part of complete blood count provides prognostic information.<ref name="pmid15893180">Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15893180 Which white blood cell subtypes predict increased cardiovascular risk?] ''J Am Coll Cardiol'' 45 (10):1638-43. [http://dx.doi.org/10.1016/j.jacc.2005.02.054 DOI:10.1016/j.jacc.2005.02.054] PMID: [http://pubmed.gov/15893180 15893180]</ref> Biomarkers, such as [[troponin]] and [[CK-MB]], are used to exclude myocardial injury. In assessment for [[Chronic stable angina risk stratification|risk factor stratification]], all patients with ischemic heart disease are recommended to have a a standard round of blood work conducted including fasting plasma glucose levels and a complete lipid profile. Serum creatinine <ref name="pmid14712425">Shlipak MG, Stehman-Breen C, Vittinghoff E, Lin F, Varosy PD, Wenger NK et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14712425 Creatinine levels and cardiovascular events in women with heart disease: do small changes matter?] ''Am J Kidney Dis'' 43 (1):37-44. PMID: [http://pubmed.gov/14712425 14712425]</ref> is used to assess renal dysfunction <ref name="pmid12706933">Fried LF, Shlipak MG, Crump C, Bleyer AJ, Gottdiener JS, Kronmal RA et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12706933 Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals.] ''J Am Coll Cardiol'' 41 (8):1364-72. PMID: [http://pubmed.gov/12706933 12706933]</ref> due to associated [[hypertension]] or [[diabetes]] and remains a negative prognostic factor. In patients with chronic stable angina, an elevation in fasting glucose <ref name="pmid14760320">Arcavi L, Behar S, Caspi A, Reshef N, Boyko V, Knobler H (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14760320 High fasting glucose levels as a predictor of worse clinical outcome in patients with coronary artery disease: results from the Bezafibrate Infarction Prevention (BIP) study.] ''Am Heart J'' 147 (2):239-45. [http://dx.doi.org/10.1016/j.ahj.2003.09.013 DOI:10.1016/j.ahj.2003.09.013] PMID: [http://pubmed.gov/14760320 14760320]</ref> independently predicts the adverse outcome. Recent research on '''NT-pro-BNP''' has demonstrated the ability to predict long-term mortality in patients with chronic stable angina independent of age, ventricular ejection fraction and other risk factors.<ref name="pmid15716560">Kragelund C, Grønning B, Køber L, Hildebrandt P, Steffensen R (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15716560 N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease.] ''N Engl J Med'' 352 (7):666-75. [http://dx.doi.org/10.1056/NEJMoa042330 DOI:10.1056/NEJMoa042330] PMID: [http://pubmed.gov/15716560 15716560]</ref>
In patients with chronic stable angina, initial laboratory investigations are used to: identify potential causes of [[ischemia]], establish risk factors, and determine the overall prognosis for the patient. An initial laboratory test can provide a wide variety of clinical information. For instance, low hemoglobin levels can cause ischemia. Therefore, assessing hemoglobin as a part of complete blood count provides prognostic information.<ref name="pmid15893180">Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15893180 Which white blood cell subtypes predict increased cardiovascular risk?] ''J Am Coll Cardiol'' 45 (10):1638-43. [http://dx.doi.org/10.1016/j.jacc.2005.02.054 DOI:10.1016/j.jacc.2005.02.054] PMID: [http://pubmed.gov/15893180 15893180]</ref> Biomarkers, such as [[troponin]] and [[CK-MB]], are used to exclude myocardial injury. In assessment for [[Chronic stable angina risk stratification|risk factor stratification]], all patients with ischemic heart disease are recommended to have a a standard round of blood work conducted including fasting plasma glucose levels and a complete lipid profile. Serum creatinine<ref name="pmid14712425">Shlipak MG, Stehman-Breen C, Vittinghoff E, Lin F, Varosy PD, Wenger NK et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14712425 Creatinine levels and cardiovascular events in women with heart disease: do small changes matter?] ''Am J Kidney Dis'' 43 (1):37-44. PMID: [http://pubmed.gov/14712425 14712425]</ref> is used to assess renal dysfunction<ref name="pmid12706933">Fried LF, Shlipak MG, Crump C, Bleyer AJ, Gottdiener JS, Kronmal RA et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12706933 Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals.] ''J Am Coll Cardiol'' 41 (8):1364-72. PMID: [http://pubmed.gov/12706933 12706933]</ref> due to associated [[hypertension]] or [[diabetes]] and remains a negative prognostic factor. In patients with chronic stable angina, an elevation in fasting glucose<ref name="pmid14760320">Arcavi L, Behar S, Caspi A, Reshef N, Boyko V, Knobler H (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14760320 High fasting glucose levels as a predictor of worse clinical outcome in patients with coronary artery disease: results from the Bezafibrate Infarction Prevention (BIP) study.] ''Am Heart J'' 147 (2):239-45. [http://dx.doi.org/10.1016/j.ahj.2003.09.013 DOI:10.1016/j.ahj.2003.09.013] PMID: [http://pubmed.gov/14760320 14760320]</ref> independently predicts the adverse outcome. Recent research on NT-pro-BNP has demonstrated the ability to predict long-term mortality in patients with chronic stable angina independent of age, ventricular ejection fraction and other risk factors.<ref name="pmid15716560">Kragelund C, Grønning B, Køber L, Hildebrandt P, Steffensen R (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15716560 N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease.] ''N Engl J Med'' 352 (7):666-75. [http://dx.doi.org/10.1056/NEJMoa042330 DOI:10.1056/NEJMoa042330] PMID: [http://pubmed.gov/15716560 15716560]</ref>


==Initial laboratory tests==
==Initial Laboratory Findings==
*[[Cholesterol|Total Cholesterol]], [[low-density lipoprotein]] cholesterol (LDL-C) <ref name="pmid11161915">Rosengren A, Dotevall A, Eriksson H, Wilhelmsen L (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11161915 Optimal risk factors in the population: prognosis, prevalence, and secular trends; data from Göteborg population studies.] ''Eur Heart J'' 22 (2):136-44. [http://dx.doi.org/10.1053/euhj.2000.2179 DOI:10.1053/euhj.2000.2179] PMID: [http://pubmed.gov/11161915 11161915]</ref> and [[high-density lipoprotein]] cholesterol (HDL-C) measurements should be performed in all patients with suspected or documented [[ischemic heart disease]].
*[[Cholesterol|Total cholesterol]], [[low-density lipoprotein]] cholesterol (LDL-C)<ref name="pmid11161915">Rosengren A, Dotevall A, Eriksson H, Wilhelmsen L (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11161915 Optimal risk factors in the population: prognosis, prevalence, and secular trends; data from Göteborg population studies.] ''Eur Heart J'' 22 (2):136-44. [http://dx.doi.org/10.1053/euhj.2000.2179 DOI:10.1053/euhj.2000.2179] PMID: [http://pubmed.gov/11161915 11161915]</ref> and [[high-density lipoprotein]] cholesterol (HDL-C) measurements should be performed in all patients with suspected or documented [[ischemic heart disease]].


*Fasting [[glucose]] level <ref name="pmid11485504">Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11485504 The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up.] ''Arch Intern Med'' 161 (14):1717-23. PMID: [http://pubmed.gov/11485504 11485504]</ref> <ref name="pmid11141143">Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11141143 Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk).] ''BMJ'' 322 (7277):15-8. PMID: [http://pubmed.gov/11141143 11141143]</ref>
*Fasting [[glucose]] level<ref name="pmid11485504">Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11485504 The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up.] ''Arch Intern Med'' 161 (14):1717-23. PMID: [http://pubmed.gov/11485504 11485504]</ref><ref name="pmid11141143">Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11141143 Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk).] ''BMJ'' 322 (7277):15-8. PMID: [http://pubmed.gov/11141143 11141143]</ref>


*Routine hematologic tests are necessary to exclude significant [[anemia]].<ref name="pmid15893180">Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15893180 Which white blood cell subtypes predict increased cardiovascular risk?] ''J Am Coll Cardiol'' 45 (10):1638-43. [http://dx.doi.org/10.1016/j.jacc.2005.02.054 DOI:10.1016/j.jacc.2005.02.054] PMID: [http://pubmed.gov/15893180 15893180]</ref>
*Routine hematologic tests are necessary to exclude significant [[anemia]].<ref name="pmid15893180">Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15893180 Which white blood cell subtypes predict increased cardiovascular risk?] ''J Am Coll Cardiol'' 45 (10):1638-43. [http://dx.doi.org/10.1016/j.jacc.2005.02.054 DOI:10.1016/j.jacc.2005.02.054] PMID: [http://pubmed.gov/15893180 15893180]</ref>
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==ESC Guidelines- Laboratory investigation in initial assessment of stable angina (DO NOT EDIT) <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
==ESC Guidelines- Laboratory Investigation in Initial Assessment of Stable Angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
{{cquote|
===[[European society of cardiology#Classes of Recommendations|Class I]] (in all patients)===
'''1.''' [[Coronary risk profile (patient information)|Fasting lipid profile]], including [[total cholesterol]], [[LDL]], [[HDL]], and [[triglycerides]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''


'''2.''' Fasting [[glucose]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I (in all patients)]]


'''3.''' Full blood count including [[Hemoglobin]] and white cell count. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Coronary risk profile (patient information)|Fasting lipid profile]], including [[total cholesterol]], [[LDL]], [[HDL]], and [[triglycerides]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Fasting [[glucose]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Full blood count including [[Hemoglobin]] and white cell count. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Creatinine]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


'''4.''' [[Creatinine]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I (if specifically indicated on the basis of clinical evaluation)]]


===[[European society of cardiology#Classes of Recommendations|Class I]] (if specifically indicated on the basis of clinical evaluation)===
|-
'''1.''' Markers of myocardial damage if evaluation suggests clinical instability or [[ACS]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Markers of myocardial damage if evaluation suggests clinical instability or [[ACS]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Thyroid function if clinically indicated. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


'''2.''' Thyroid function if clinically indicated. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[European society of cardiology#Classes of Recommendations|Class IIa]]


===[[European society of cardiology#Classes of Recommendations|Class IIa]]===
|-
'''1.''' [[Oral glucose tolerance test]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Oral glucose tolerance test]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


===[[European society of cardiology#Classes of Recommendations|Class IIb]]===
{|class="wikitable"
'''1.''' Hs-[[C-reactive protein]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[European society of cardiology#Classes of Recommendations|Class IIb]]


'''2.''' Lipoprotein a, ApoA, and ApoB . ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Hs-[[C-reactive protein]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Lipoprotein a, ApoA, and ApoB . ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[Homocysteine]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' [[HbA1c]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' [[BNP|NT-BNP]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


'''3.''' [[Homocysteine]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
==ESC Guidelines- Blood Tests for Routine Reassessment in Patients with Chronic Stable Angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==


'''4.''' [[HbA1c]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[European society of cardiology#Classes of Recommendations|Class IIa]]


'''5.''' [[BNP|NT-BNP]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''}}
|-
 
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Coronary risk profile (patient information)|Fasting lipid profile]] and fasting [[glucose]] on an annual basis. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
==ESC Guidelines- Blood tests for routine reassessment in patients with chronic stable angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
|}
{{cquote|
===[[European society of cardiology#Classes of Recommendations|Class IIa]]===
'''1.''' [[Coronary risk profile (patient information)|Fasting lipid profile]] and fasting [[glucose]] on an annual basis. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''}}
 
==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
 
==Guidelines Resources==
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>
 
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>
 
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>
 
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref>


==References==
==References==
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Latest revision as of 17:09, 6 February 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S. [3]

Overview

In patients with chronic stable angina, initial laboratory investigations are used to: identify potential causes of ischemia, establish risk factors, and determine the overall prognosis for the patient. An initial laboratory test can provide a wide variety of clinical information. For instance, low hemoglobin levels can cause ischemia. Therefore, assessing hemoglobin as a part of complete blood count provides prognostic information.[1] Biomarkers, such as troponin and CK-MB, are used to exclude myocardial injury. In assessment for risk factor stratification, all patients with ischemic heart disease are recommended to have a a standard round of blood work conducted including fasting plasma glucose levels and a complete lipid profile. Serum creatinine[2] is used to assess renal dysfunction[3] due to associated hypertension or diabetes and remains a negative prognostic factor. In patients with chronic stable angina, an elevation in fasting glucose[4] independently predicts the adverse outcome. Recent research on NT-pro-BNP has demonstrated the ability to predict long-term mortality in patients with chronic stable angina independent of age, ventricular ejection fraction and other risk factors.[5]

Initial Laboratory Findings

  • Routine hematologic tests are necessary to exclude significant anemia.[1]
  • Homocysteinemia has been found to be a risk factor for coronary artery disease.[9] Folate, vitamin B12 and vitamin B6 can lower the homocysteine level. Although the therapeutic implications of lowering homocysteine levels have not been fully defined, homocysteine concentrations should be measured in patients with a strong family history of coronary disease, especially if it is not explained by traditional risk factors.

ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[10]

Initial Laboratory Tests for Diagnosis (DO NOT EDIT)[10]

Class I
"1. Hemoglobin. (Level of Evidence: C)"
"2. Fasting glucose. (Level of Evidence: C)
"3. Fasting lipid panel, including total cholesterol, HDL cholesterol, triglycerides, and calculated LDL cholesterol. (Level of Evidence: C)

ESC Guidelines- Laboratory Investigation in Initial Assessment of Stable Angina (DO NOT EDIT)[11]

Class I (in all patients)
"1. Fasting lipid profile, including total cholesterol, LDL, HDL, and triglycerides. (Level of Evidence: B)"
"1. Fasting glucose. (Level of Evidence: B)"
"1. Full blood count including Hemoglobin and white cell count. (Level of Evidence: B)"
"1. Creatinine. (Level of Evidence: C)"
Class I (if specifically indicated on the basis of clinical evaluation)
"1. Markers of myocardial damage if evaluation suggests clinical instability or ACS. (Level of Evidence: A)"
"2. Thyroid function if clinically indicated. (Level of Evidence: C)"
Class IIa
"1. Oral glucose tolerance test. (Level of Evidence: B)"
Class IIb
"1. Hs-C-reactive protein. (Level of Evidence: B)"
"2. Lipoprotein a, ApoA, and ApoB . (Level of Evidence: B)"
"3. Homocysteine. (Level of Evidence: B)"
"4. HbA1c. (Level of Evidence: B)"
"5. NT-BNP. (Level of Evidence: B)"

ESC Guidelines- Blood Tests for Routine Reassessment in Patients with Chronic Stable Angina (DO NOT EDIT)[11]

Class IIa
"1. Fasting lipid profile and fasting glucose on an annual basis. (Level of Evidence: C)"

References

  1. ↑ 1.0 1.1 Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR et al. (2005) Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 45 (10):1638-43. DOI:10.1016/j.jacc.2005.02.054 PMID: 15893180
  2. ↑ Shlipak MG, Stehman-Breen C, Vittinghoff E, Lin F, Varosy PD, Wenger NK et al. (2004) Creatinine levels and cardiovascular events in women with heart disease: do small changes matter? Am J Kidney Dis 43 (1):37-44. PMID: 14712425
  3. ↑ Fried LF, Shlipak MG, Crump C, Bleyer AJ, Gottdiener JS, Kronmal RA et al. (2003) Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 41 (8):1364-72. PMID: 12706933
  4. ↑ Arcavi L, Behar S, Caspi A, Reshef N, Boyko V, Knobler H (2004) High fasting glucose levels as a predictor of worse clinical outcome in patients with coronary artery disease: results from the Bezafibrate Infarction Prevention (BIP) study. Am Heart J 147 (2):239-45. DOI:10.1016/j.ahj.2003.09.013 PMID: 14760320
  5. ↑ Kragelund C, Grønning B, Køber L, Hildebrandt P, Steffensen R (2005) N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 352 (7):666-75. DOI:10.1056/NEJMoa042330 PMID: 15716560
  6. ↑ Rosengren A, Dotevall A, Eriksson H, Wilhelmsen L (2001) Optimal risk factors in the population: prognosis, prevalence, and secular trends; data from Göteborg population studies. Eur Heart J 22 (2):136-44. DOI:10.1053/euhj.2000.2179 PMID: 11161915
  7. ↑ Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE et al. (2001) The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up. Arch Intern Med 161 (14):1717-23. PMID: 11485504
  8. ↑ Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A et al. (2001) Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ 322 (7277):15-8. PMID: 11141143
  9. ↑ Nygård O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE (1997) Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med 337 (4):230-6. DOI:10.1056/NEJM199707243370403 PMID: 9227928
  10. ↑ 10.0 10.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM; et al. (1999). "ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina)". Circulation. 99 (21): 2829–48. PMID 10351980.
  11. ↑ 11.0 11.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.

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