Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics

Abstract

Objectives Patients with acute coronary syndrome (ACS) should be referred promptly to the hospital to reduce mortality and morbidity. Differentiating between low-risk and high-risk patients remains a diagnostic challenge. Point-of-care testing can contribute to earlier disposition decisions for patients excluded from ACS. This study describes the validation of the Atellica® VTLi. Patient-side Immunoassay Analyzer for high-sensitivity troponin point-of-care (POC) analysis. (The Atellica VTLi is not available for sale in the USA. The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed). Methods A total of 152 patients with acute chest pain admitted at the cardiac emergency department (ED) were included in the study. Capillary blood was compared with a whole blood and plasma sample obtained by venipuncture. All samples were analyzed using the Atellica VTLi Patient-side Immunoassay Analyzer; in addition, plasma was analyzed by a central lab immunoassay analyzer. Results No significant difference was observed between venous whole blood vs. plasma analyzed by the Atellica VTLi Patient-side Immunoassay Analyzer. The difference between capillary blood and venous blood showed a constant bias of 7.1%, for which a correction factor has been implemented. No clinically relevant differences were observed for the capillary POC results compared to plasma analyzed with a standard immunoassay analyzer. Conclusions The Atellica VTLi Patient-side Immunoassay Analyzer for high-sensitivity troponin analysis shows equivalent results for all sample types, including capillary blood. No clinically relevant discordances were observed between capillary POC and central laboratory results. With additional studies, this could pave the way towards rapid testing of high-sensitivity troponin in the ambulance or the general practitioner’s office without the need for hospitalization of patients with acute chest pain.

Real-life evaluation of hypersensitive I-troponin on a point-of care analyser in an emergency unit

“…Ses performances analytiques lui permettent d'obtenir les mêmes performances diagnostiques pour un SCA ST-que celles obtenues par un dosage de Tn-hs mesuré en intra laboratoire par des méthodes conventionnelles comme Abbott ou Siemens [15,18]. Quel que soit la matrice utilisée (sang total, plasma ou capillaire), les performances analytiques restent comparables [22].…”

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

“…18 A very pragmatic approach results from the use of Atellica VTLi Patient-side immunoassay analyzer, which showed equivalent results for all types of blood sampled, including capillary blood, which may represent a significant advantage in the ED. 19 According to the currently published data, the best diagnostic performance of high-sensitivity troponin is recorded in patients with low CV risk, in whom the investigators recorded the highest specificity and negative predictive values for coronary artery disease (CAD). 20 The diagnostic accuracy of absolute versus relative changes in Tn values was investigated by Ravanavena et al, who found that absolute increase in cTn may be superior to the relative change of cTn serum values to predict evolution in patients with ACS.…”

Measurement of Cardiac-Specific Biomarkers in the Emergency Department: New Insight in Risk Evaluation

“…This recommendation is based on data suggesting that these algorithms (especially the 0-1 h algorithm) allow to rule in and rule out NSTEMI in the shortest possible time [15]. Furthermore, in the last 5 years, the clinical results of some point-of-care-testing (POCT) methods (i.e., hs-cTnI POCT), with analytical performance equal to hs-cTnI methods, have been developed and evaluated [25][26][27][28][29][30][31][32][33][34][35][36].…”

“…Considering these analytical improvements and clinical evidence [14][15][16][17][18][19][25][26][27][28][29][30][31][32][33][34][35][36], recent documents and guidelines [14][15][16][17]36,37] recommend the use of accelerated diagnostic protocols, based on the use of hs-cTn, in order to reduce the length of stay in the ED and hospital and thus reducing costs related to the management of patients with thoracic pain, ACS, or acute heart failure (AHF).…”