Implementing a high sensitivity point-of-care troponin assay is beneficial in an emergency department chest pain population

Abstract

Point of care tests (POC) can provide accurate and more rapid results for physicians at the bedside, thus decreasing the patient’s time to treatment and increasing patient prognosis. Cardiac troponin (cTnI) is the leading biomarker used in the diagnosis of acute myocardial infarction (MI) and acute coronary syndrome (ACS). It is hypothesized that results from the MERITAS cTnI POC analyzer will predict the proper diagnosis and course of treatment and will improve long-term prognosis for patients presenting to the emergency department with symptoms of acute coronary syndrome. Subjects presenting to Vidant Medical Center (VMC) Emergency Department with symptoms of ACS were consented for participation according to IRB protocol. Up to four blood samples were collected and analyzed with the MERITAS cTnI POC analyzer at baseline of enrollment (0 hours), 2-4 hours, 6-9 hours, and 12-24 hours after baseline enrollment. A medical record review was later conducted for each subject to extract parallel VMC cTnI values, MI diagnosis, and cardiac intervention information. The POC analysis of whole blood has 98% negative predictive value (NPV) of MI and 92% NPV of cardiac intervention. The POC analysis of plasma and the VMC cTnI assay have 100% NPV for MI and 93% NPV of cardiac intervention. The sensitivity of the POC analysis of whole blood is 93% and 64% for MI and cardiac intervention, respectively. The sensitivity of the POC analysis of plasma and the VMC assay is 100% with respect to MI, and 72% and 73% for MI and cardiac intervention, respectively. It can be concluded that analyzing patient plasma using the MERITAS cTnI POC analyzer is diagnostically equal to the traditional VMC cTnI assay and therefore improves patient prognosis by decreasing time to treatment.