Importance and Sensitivity of Point-of-Care Cardiac Troponin Testing for the Diagnosis of Acute Coronary Syndrome and Acute Myocardial Infarction
Keywords:
Point-of-care; cardiac troponin; myocardial infarction; acute coronary syndrome.Abstract
Objective: To evaluate the importance and sensitivity of POC cTn testing for the diagnosis of ACS and AMI.
Methods: A literature review of papers indexed in the PubMed, Scopus, LILACS, and Cochrane databases was conducted in July 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group guidelines. For inclusion, the papers had to be original, be developed on humans, involve POC cTn testing, and address the diagnosis of AMI or ACS.
Results: Forty-three papers published between 1997 and 2020 were selected, providing data on a total of 51,410 individuals aged 18 to 98. The studies indicated the importance of POC cTn testing for diagnosing AMI and ACS, as well as its prognostic usefulness.
The POC tests were found to have good discriminatory power, showing median sensitivity, specificity, and negative and positive predictive values of 79.0%, 94.0%, 94.6%, and 62.5%, respectively. They were found to have an analytical performance equivalent to laboratory cTn tests, while having the advantage of providing results more quickly. Conclusion: POC cTn testing is rapid, sensitive diagnostic tool for ACS and AMI.
Downloads
References
Alghamdi A, Reynard C, Morris N, Moss P, JarmanH, Hardy E, et al. Diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a point-of-care cardiac troponin assay. EmergMed J. 2020;37(4):223-228.
Gonçalves SM, Gomes KB, Carvalho M das G, Magalhães H, Reis E, Silva I. Effectiveness to identify acute myocardial infarction using the Manchester screening in patients with chest pain at the emergency service. J Clin Lab Anal. 2018; 32(6).
Hung CL, Chien DK, Shih SC, Chang, WH et al. The feasibility and diagnostic accuracy by multiple cardiac biomarkers in emergency chest pain patients: A clinical analysis to compare 290 suspected acute coronary syndrome cases stratified by age and gender in Taiwan. BMC CardiovascDisord. 2016;16(1).
Hachey BJ, Kontos MC, Newby LK, Christenson R, Peacock W, Brewer .K, et al. Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction. J Am Heart Assoc. 2017; 6(9).
Regan B, O’Kennedy R, Collins D. Point-of-care compatibility of ultra-sensitive detection techniques for the cardiac biomarker troponin I—challenges and potential value. Biosensors. 2018;8(4).
Moher D, Liberati A, Tetzlaff J, Altman D. Guidelines and Guidance Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute. 2013;3: 1–4.
Andersson PO, Karlsson JE, Landberg E, Festin K, Nilsson S. Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: An observational prospective study Cardiovascular Disorders. BMC Res Notes. 2015; 8(1).
Asha SE, Cooke A, Walter E, Weaver J. Three-month outcome of patients with suspected acute coronary syndrome using point-of-care cardiac troponin-T testing compared with laboratory-based cardiac troponin-T testing: A randomised trial. Emerg Med J. 2015; 32(8): 601-607.
Ezekowitz JA, Welsh RC, Weiss D, Chan M, Keeble W, Khadour F, Sharma S, et al. Providing Rapid Out of Hospital Acute Cardiovascular Treatment 4 (PROACT-4). J Am Heart Assoc. 2015; 4(12).
Ezekowitz JA, Welsh RC, Gubbels C, Brass N, Chan M, Keeble W, Khadour F, et al. Providing rapid out of hospital acute cardiovascular treatment 3 (PROACT-3). Can J Cardiol. 2014; 30(10): 1208-1215.
Palamalai V, Murakami MAM, Apple FS. Diagnostic performance of four point of care cardiac troponin I assays to rule in and rule out acute myocardial infarction. ClinBiochem. 2013; 46(16-17): 1631-1635.
Schneider HG, Ablitt P, Taylor J. Improved sensitivity of point of care troponin I values using reporting to below the 99th percentile of normals. ClinBiochem. 2013; 46(12): 979-982
Stengaard C, Sørensen JT, Ladefoged SA, Christensen E, Lassen J, Bøtker, HE, et al. Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction. Am J Cardiol. 2013;112(9):1361-1366.
Collinson P, Goodacre S, Gaze D, Gray A. Very early diagnosis of chest pain by point-of-care testing: Comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial. Heart. 2012; 98(4): 312-318
Diercks DB, Peacock IV WF, Hollander JE, Singer AJ, Birkhahn R, Shapiro N, et al. Diagnostic accuracy of a point-of-care troponin i assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. Am Heart J. 2012;163(1).
Lee-Lewandrowski E, Januzzi JL, Grisson R, Mohammed AA, Lewandrowski, G, Lewandrowski, K. Evaluation of first-draw whole blood, point-of-care cardiac markers in the context of the universal definition of myocardial infarction: A comparison of a multimarker panel to troponin alone and to testing in the central laboratory. Arch Pathol Lab Med. 2011;135(4):459-463.
Alghamdi A, Cook E, Carlton E, Siriwaderna A, Hann M, Thompson A, et al. PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: Multicentre prospective diagnostic accuracy study protocol. BMJ. 2019;9(10).
Sørensen JT, Terkelsen CJ, Steengaard C, Lassen J, Trautner S, Christensen E, et al. Prehospital troponin T testing in the diagnosis and triage of patients with suspected acute myocardial infarction. Am J Cardiol. 2011;107(10):1436-1440.
Tomonaga Y, Gutzwiller F, Lüscher TF, Riesen WF, Hug M, Diemand A, et al. Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: A cluster-randomised controlled trial. BMC FamPract. 2011;12.
Macdonald SPJ, Nagree Y. Rapid risk stratification in suspected acute coronary syndrome using serial multiple cardiac biomarkers: A pilot study. EMA - Emerg Med Australas. 2008; 20(5):403-409.
Straface AL, Myers JH, Kirchick HJ, Blick KE. A rapid point-of-care cardiac marker testing strategy facilitates the rapid diagnosis and management of chest pain patients in the emergency department. Am J ClinPathol. 2008;129(5):788-795.
Apple FS, Chung AY, Kogut ME, Bubany S, Murakami MM. Decreased patient charges following implementation of point-of-care cardiac troponin monitoring in acute coronary syndrome patients in a community hospital cardiology unit. ClinChimActa. 2007; 370(1-2):191-195.
Cramer GE, Kievit PC, Brouwer MA, Keijzer MH, Luijten HE Verheugt FWA. Lack of concordance between a rapid bedside and conventional laboratory method of cardiac troponin testing: Impact on risk stratification of patients suspected of acute coronary syndrome. ClinChimActa. 2007;381(2):164-166.
Möckel M, Müller R, Vollert JO, Müller C, Danne O, Gareis, R,et al. Lipoprotein-associated phospholipase A2 for early risk stratification in patients with suspected acute coronary syndrome: A multi-marker approach - The North Wuerttemberg and Berlin Infarction Study-II (NOBIS-II). Clin Res Cardiol. 2007;96(9):604-612.
Apple F, Ler R, Chung A, Berger M, Murakami M. Point-of-Care i-STAT Cardiac Troponin I for Assess-ment of Patients with Symptoms Suggestive of Acute Coronary Syndrome. Clin Chem. 2006;52(2):322-325.
Borrayo-Sánchez G, Sosa-Jarero F,Borja-Terán B, Isordia-Salas I, Argüero-Sánchez R. Determinacióncualitativa de marcadores de necrosis miocárdica desde la fase prehospitalariadel síndrome coronario agudo. Cir Cir. 2006;74:231-235.
Di Serio F, Lovero R, Leone M, De Sario M, Ruggieri, V, Varraso,et al.Integration between the Tele-Cardiology Unit and the central laboratory: Methodological and clinical evaluation of point-of-care testing cardiac marker in the ambulance. In: Clinical Chemistry and Laboratory Medicine; 44 ; 2006:768-773.
Body R, Almashali M, Morris N, Moss P, Jarman H, Appelboam A, et al. Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay. Heart. 2019;105(10):768-774.
Ordóñez-Llanos J, Santaló-Bel M, Mercé-Muntañola J, Collinson P, Gaze D, Haass M, et al. Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department. ClinChim Acta. 2006; 365(1-2): 93-97.
Soria CAM, Alejo GC, González JJE, Sánchez JÁ, SánchezJM, et al. Utilidad de ladeterminacióncualitativa de troponina I y creatinfosfocinasaisoenzima MB enlos síndromes isquémicoscoronarios agudos. Arch Cardiol Mex. 2006;76(1):37-46.
Hindle HR, Hindle SK. Qualitative troponin I estimation in the diagnosis of acute coronary syndromes in three rural hospitals. Can J Rural Med. 2005;10(4):225-230.
Seino Y, Tomita Y, Takano T, Ohbayashi K. Office Cardiologists Cooperative Study on Whole Blood Rapid Panel Tests in Patients With Suspicious Acute Myocardial Infarction Comparison Between Heart-Type Fatty Acid-Binding Protein and Troponin T Tests. CURCULATION J. 2004;68:144-148.
Agewall S. Evaluation of point-of-care test systems using the new definition of myocardial infarction. ClinBiochem. 2003; 36(1):27-30.
Caragher TE, Fernandez BB, Jacobs FL, Barr LA. Evaluation of quantitative cardiac biomarker point-of-care testing in the emergency department. J Emerg Med. 2002; 22(1): 1-7.
McCord J, Nowak RM, McCullough PA, Foreback C, Borzak S, Tokarski G, et al. Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I. Circulation. 2001;104(13):1483-1488.
Apple FS, Anderson FP, Collinson P, Jesse RL, Kontos MC, Levitt MA, et al. Clinical evaluation of the first medical whole blood, point-of-care testing device for detection of myocardial infarction. Clin Chem. 2000;46(10):1604-1609.
Heeschen C, Goldmann BU, Langenbrink L, Matschuck L, Matschuck G, Hamm CH. Evaluation of a Rapid Whole Blood ELISA for Quantification of Troponin I in Patients with Acute Chest Pain.ClinChem; 1999:45(10):1789–1796.
Ohman EM, Armstrong PW, White HD, Granger CB, Wilcox RG, Weaver WD, et al. Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction. Am J Cardiol. 1999;84(11):1281-1286
Suzuki K, Komukai K, Nakata K, Kang R, Oi Y, Muto E,et al. The usefulness and limitations of point-of-care cardiac troponin measurement in the emergency department. Intern Med. 2018;57(12):1673-1680.
Sylven C, Lindahl S, Hellkvist K, Nyquist O, Rasmanis G. Excellent reliability of nurse-based bedside diagnosis of acute myocardial infarction by rapid dry-strip creatine kinase MB, myoglobin, and troponin T. Am Heart J. 1998;135(4):677-683.
Baxter MS, Brogan GX, Harchelroad FP, Knoop KJ, Zackowski SW, Ryan RJ, et al. Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department. AcadEmerg Med. 1997;4(11):1018-1024.
Cho YD, Lee SW, Yoon YH, Kin JY. The utility of point-of-care biomarkers as a prognostic tool for patients with acute coronary syndromes. Signa Vitae. 2017; 13(1): 89-94.
Greiser A, Winter T, Mahfoud H, Kallner A, Ittermann T, Masuch A, et al. The 99th percentile and imprecision of point-of-care cardiac troponin I in comparison to central laboratory tests in a large reference population. ClinBiochem. 2017;50(18):1198-1202.
Slagman A, von Recum J, Möckel M, Holert F, ZumBüschenfelde D, Müller C, et al. Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department: A clinical cohort study. Int J Cardiol. 2017;230:454-460.
Tsai W, Chien DK, Huang CH, Shih SC, Chang WH. Multiple Cardiac Biomarkers Used in Clinical Guideline for Elderly Patients with Acute Coronary Syndrome. Int J Gerontol. 2017;11(2):104-108.
Wilke P, Masuch A, Fahron O, Zylla S, Leipold T, Petersmann A. Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. PLoS One. 2017;12(11).
Downloads
Published
Issue
Section
License
Copyright (c) 2021 International Journal of Biomedical Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- An author must submit Copyright form After acceptance of the article.