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Objectives. The main aim of the Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain (WESTCOR-study) (Clinical Trials number NCT02620202) is to improve diagnostic pathways for patients presenting to the Emergency department (ED) with acute chest pain. Design. The WESTCOR-study is a two center, cross-sectional and prospective observational study recruiting unselected patients presenting to the ED with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). Patient inclusion started September 2015 and we plan to include 2250 patients, finishing in 2019. The final diagnosis will be adjudicated by two independent cardiologists based on all available information including serial high sensitivity cardiac troponin measurements, coronary angiography, coronary CT angiography and echocardiography. The study includes one derivation cohort (N = 985) that will be used to develop rule out/rule in algorithms for NSTEMI and NSTE-ACS (if possible) using novel troponin assays, and to validate established NSTEMI algorithms, with and without clinical scoring systems. The study further includes one subcohort (n = 500) where all patients are examined with coronary CT angiography independent of biomarker status, aiming to assess the associations between biomarkers and the extent and severity of coronary atherosclerosis. Finally, an external validation cohort (N = 750) will be included at Stavanger University Hospital. Prospective studies will be based on the merged cohorts. Conclusion. The WESTCOR study will provide new diagnostic algorithms for early inclusion and exclusion of NSTE-ACS and insights in the associations between cardiovascular biomarkers, CT-angiographic findings and short and long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to elucidate how laboratory specialists advise clinicians concerning renal parameters and to compare their advice with guideline recommendations. Methods. A questionnaire was distributed to laboratory specialists in Norway and The Netherlands together with two case histories from a primary health-care setting and one from a hospital setting, simulating questions from clinicians. The investigations that laboratory specialists suggested were compared to a test panel that was predefined based on clinical practice guideline recommendations (the 'recommended test panel'). The critical differences between two test results (creatinine, estimated glomerular filtration rate [eGFR] and albumin/creatinine ratio [ACR]) and the anticipated precision of the MDRD equation were evaluated. Results. Fifty-two of the 100 laboratory specialists responded, and most of these were regularly contacted by clinicians to discuss laboratory results. Less than 30% would suggest using the recommended test panel to evaluate renal function in the two primary-care patients. For creatinine and eGFR, median changes stated to signal improvement or deterioration in renal function (creatinine: −14% and ++14%, respectively; eGFR: ++ 18% and −13%, respectively) were similar to what could be calculated using information on analytical and within-subject variation from the literature. There were variable critical differences for the ACR results (median values of −50% for improvement and ++ 67% for deterioration). Only 23% of the participants would recommend a gold standard clearance examination for a patient who was to undergo nephrotoxic chemotherapy. Conclusion. Questions from GPs about renal parameters are answered differently by laboratory specialists, and adherences to guideline recommendations are low on some issues. [ABSTRACT FROM AUTHOR]