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Novel point-of-care troponin assay yields similar results to high-sensitivity cardiac assay
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A novel point-of-care troponin assay had similar discrimination ability compared with a high-sensitivity cardiac troponin I assay to rule out acute MI in patients who presented with symptoms at an ED, according to a study published in JAMA Cardiology.
John W. Pickering, PhD, associate professor in medicine and senior research fellow in acute care at University of Otago in Christchurch, New Zealand, and colleagues analyzed data from 354 patients (mean age, 62 years; 72% men) who presented to an ED with symptoms of possible ACS between July 2016 and January 2018. Troponin concentrations were measured with a novel point-of-care assay (i-STAT TnI-Nx; Abbott Point of Care) and a high-sensitivity troponin I assay (Architect hs-cTnI; Abbott Diagnostics). The novel assay can be used with whole blood or plasma and takes approximately 15 minutes.
The primary outcome was index presentation type 1 acute MI.
Acute MI occurred in 16.1% of patients in the study. Twenty-four percent of patients went to the ED less than 3 hours after the onset of symptoms.
The area under receive operator characteristic curve was similar (P = .46) in the novel assay (0.975; 95% CI, 0.958-0.993) and the high-sensitivity cardiac troponin I assay (0.97; 95% CI, 0.949-0.99).
A troponin concentration of less than 11 ng/L as identified by the novel point-of-care assay occurred in 56.7% of patients, identifying them as low-risk, with a sensitivity of 100% (95% CI, 93.7-100) and a negative predictive value of 100% (95% CI, 98.2-100). A concentration of less than 3 ng/L with the high-sensitivity cardiac troponin I assay identified 43.5% of patients as low risk, with a sensitivity of 100% (95% CI, 93.7-100) and a negative predictive value of 100% (95% CI, 97.6-100).
“Additional usefulness of this assay is likely to be found outside of the ED, such as in rural hospitals and general practices where there is limited rapid access to laboratory-based troponin assays,” Pickering and colleagues wrote. “A point-of-care assay able to accurately rule out [acute] MI may prevent long and unnecessary transfers to secondary hospitals. Application of the assay within ambulances may also be possible.” – by Darlene Dobkowski
Disclosures: The study was supported by a research grant from Abbott Point of Care. Pickering reports he received travel reimbursement from Abbott. Please see the study for all other authors’ relevant financial disclosures.
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