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

Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial

“…p-Values are shown for each characteristic; p-values for sex, race, and TIMI risk score represent the relationship between diagnosis and all levels of the characteristic. These findings support recent reports suggesting that the majority of patients with MI can be identified at earlier observation times [8][9][10][11][12][13][14][15][16][17]. Our study reinforces the consensus recommendations [18,19] for optimal blood sampling at admission and 3 h later.…”

Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making

“…The study concluded that the high-sensitivity POCT produced a good diagnostic accuracy compared to central laboratory assays; at 3 h the POCT showed 84.7% sensitivity, 93.4% specificity, 60.4% PPV, 98.1% NPV, and an AUC of 0.95 to diagnose acute MI in a subpopulation diagnosed with ACS. Furthermore, serial testing beyond 3 h did not improve assay performance for ACS [18].…”

Managing Troponin Testing

“…21 Point-ofcare assays currently do not share these performance characteristics. 22 Contemporary troponin assays (those with moderate sensitivity) alone do not reduce the miss rate to less than 1%, but combining troponin testing with some features of the clinical presentation achieves that goal. Two large trials, ASPECT and ADAPT, 23,24 found that a combination of a nonischemic ECG, 2 troponins 2 hours apart, and a TIMI score of 0 had a 0.3% to 0.9% prevalence of 30-day adverse events rates (including acute myocardial infarction).…”

“…[19][20][21][22][23][24][25][26] Using several different assays, Reichlin et al 19 and Keller et al 20 found very high sensitivities (>90%) at presentation that approached 100% by 3 hours. Performance characteristics at 3 hours were similar between standard contemporary and high-sensitivity troponins.…”