The Usefulness and Limitations of Point-of-care Cardiac Troponin Measurement in the Emergency Department

Abstract

Objective This study was carried out to examine the usefulness of point-of-care (POC) cardiac troponin in diagnosing acute coronary syndrome (ACS) and to understand the limitations of a POC cardiac troponin I/T-based diagnoses. Methods Patients whose cardiac troponin levels were measured in the emergency department using a POC system (AQT System; Radiometer, Tokyo, Japan) between January and December 2016 were retrospectively examined (N=1,449). Patients who were < 20 years of age or who were admitted with cardiopulmonary arrest were excluded. The sensitivity and specificity of the POC cardiac troponin levels for the diagnosis of ACS were determined. Result One hundred and twenty of 1,449 total patients had ACS (acute myocardial infarction, n=88; unstable angina n=32). On comparing the receiver operating characteristic (ROC) curves, the area under the curve (AUC) values for POC cardiac troponin I and cardiac troponin T were 0.833 and 0.786, respectively. The sensitivity and specificity of POC cardiac troponin I when using the 99th percentile (0.023 ng/mL) as the diagnostic cut-off value were 69.0% and 88.1%, respectively. The sensitivity of POC cardiac troponin I (99th percentile) was higher in the patients sampled > 3 hours after symptom onset (83.3%) than in those sampled ≤ 3 hours after symptom onset (58.8%, p < 0.01). Conclusion When sampled > 3 hours after the onset of symptoms, the POC cardiac troponin I level is considered to be suitable for use in diagnosing ACS. However, when sampled ≤ 3 hours after the onset of symptoms, careful interpretation of POC cardiac troponins is therefore required to rule out ACS.

Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam

“… 39 , 40 Japanese authors recently assessed the usefulness of POC cTn in the emergency department. 41 A POC study conducted in an emergency department in Taiwan demonstrated the advantages of using multiple cardiac biomarkers to improve diagnosis of elderly and female patients, 42 challenging groups for diagnosis, who would benefit in Vietnam.…”

Evaluation of Molecularly Imprinted Polymers for Point-of-Care Testing for Cardiovascular Disease

“…Current commercial cardiac POC platforms are capable of yielding results more rapidly than laboratory-based assays, although this improvement typically comes at the cost of decreased accuracy and sensitivity [188]. In a recent study carried out by Suzuki et al, it was established that the sensitivity of Radiometer’s AQT90 FLEX Analyser was 58.8% when used within the first three h of AMI symptom onset [189]. Similarly, Quidel’s Triage ® Cardiac panel displays a clinical sensitivity of just 65.0% during these vital early hours of AMI [190].…”

Serum MG53/TRIM72 Is Associated With the Presence and Severity of Coronary Artery Disease and Acute Myocardial Infarction

“…AMI can cause cardiac rupture, lethal arrhythmia, and heart failure (Negre-Salvayre et al, 2017). Although AMI can be successfully diagnosed using biomarkers, such as cardiac troponin and creatine kinase (CK), the usefulness of some of these conventional biomarkers in the acute stage of AMI are limited as they could have low concentrations at this stage (Suzuki et al, 2018). Hence, there is a persistent demand for biomarkers that can identify patients with AMI in the acute phase.…”