Considerations and pragmatic strategies for implementation of point of care testing for high sensitivity cardiac troponin into the acute care setting

Q: What is the clinical evidence from this study?

Study design: Review. Population: Patients with suspected acute coronary syndrome presenting to acute care settings such as emergency departments requiring rapid risk stratification using high sensitivity cardiac troponin assays. Intervention: Point of care testing (POC) for high sensitivity cardiac troponin (hs-cTn) vs. Central laboratory hs-cTn assay. Primary outcome: Sensitivity and negative predictive value (NPV) for non-ST elevation myocardial infarction (NSTEMI) when using high sensitivity cardiac troponin assays in accelerated diagnostic protocols (ADPs) (Sensitivity 97.5-99%, NPV >99.5%).

Paul Collinson; Leo Lam; John W. Pickering; Robert Christenson; Lieve Van Hoovels; Lena Jafri; Louise Cullen; Allan S. Jaffe; Fred S. Apple; Ola Hammarsten; Torbjørn Omland; Yader Sandoval; Nicholas L. Mills; Martin Than; Vanessa Buchan; Sverre Sandberg; Kristin M. Aakre

doi:10.1515/cclm-2026-0210

March 5, 2026Clinical Chemistry and Laboratory Medicine (CCLM)Open Access

Considerations and pragmatic strategies for implementation of point of care testing for high sensitivity cardiac troponin into the acute care setting

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Key result

POC hs-cTn performs comparably to central lab assays, achieving >99.5% NPV for NSTEMI.

Sensitivity 97.5-99%, NPV >99.5%

Why the study?

Turnaround time for cardiac troponin challenges rapid risk-stratification in suspected ACS, and there is a lack of consensus on how point-of-care hs-cTn instruments should be evaluated and deployed in routine practice.

Key Points

Provide a pragmatic framework and recommendations for evaluating, verifying, and implementing point-of-care high-sensitivity cardiac troponin assays into acute clinical care pathways.
Synthesized expert recommendations through the International Federation of Clinical Chemistry and Laboratory Medicine Committee on Clinical Application of Cardiac Bio-Markers (IFCC C-CB).
Delineated manufacturer responsibilities for assay validation and local clinical laboratory requirements for verification before routine clinical adoption.
Structured implementation strategies for accelerated diagnostic pathways comparing point-of-care whole-blood analysis with central laboratory platforms.
Required high-sensitivity assays to detect cardiac troponin above the limit of detection in ≥50 % of males and ≥50 % females with an analytical imprecision of <10 % total coefficient of variation at sex-specific 99th percentiles.
Reported that discordance between point-of-care and central laboratory assays mirrors variations between different central laboratory platforms and is less than differences between troponin I and troponin T concentrations.
Advised against using point-of-care and central laboratory assays interchangeably during serial testing in a single patient admission due to differing 99th percentile upper reference limits and cut-off values.

Structured PICO

P

Population

Patients with suspected acute coronary syndrome in acute care settings

I

Intervention

Point of care (POC) testing for high sensitivity cardiac troponin (hs-cTn)

C

Comparator

Central laboratory hs-cTn testing

Main Result

Effect estimate: Sensitivity 97.5-99%, NPV >99.5%

Absolute Event Rate: 97.5% vs 99.5%

This IFCC C-CB educational document provides expert consensus guidance on the practical implementation and verification of point-of-care high-sensitivity cardiac troponin testing for rapid risk-stratification of suspected acute coronary syndrome.

Limitations

The paper is a narrative review and does not report primary clinical trial data or meta-analytical quantitative synthesis.
Lack of direct head-to-head randomized controlled trial evidence comparing outcomes with POC hs-cTn testing versus central laboratory testing.
Analytical and clinical validation data are often manufacturer-driven and vary between assays; user-level local verification is recommended but can be limited by practical constraints.
Variability and discordance exist between different hs-cTn assays and matrix types (whole blood vs plasma), requiring local protocols for interpretation and clinical pathways.
No exact sample size or demographic data for populations analyzed in validation studies provided in the review.

Implication

Supports rapid ACS triage with POC hs-cTn in practice; extends expert consensus on implementation and verification.

Abstract

A challenge in the implementation of rapid risk-stratification algorithms for patients with suspected acute coronary syndrome is the turnaround time for cardiac troponin (cTn) from blood sampling to reporting of results. Measurement of cTn in whole blood using point of care (POC) offers a solution. There is lack of consensus on how these instruments should be assessed and deployed when implemented into routine practice. A pragmatic strategy is needed to balance the requirement for appropriate evaluation, validation and local verification of POC high sensitivity (hs) cTn assays whilst avoiding unnecessary duplication of previously conducted work using central laboratory assays. The International Federation of Clinical Chemistry and Laboratory Medicine Committee on Clinical Application of Cardiac Bio-Markers (IFCC C-CB) has developed an educational document to provide practical suggestions as to how hs-cTn POC assays may be implemented in acute health care settings and networks. The objective of this document is to provide a pragmatic framework for implementation of such systems. The article describes the validation and verification procedures and outlines what should be the responsibility of the manufacturers and provides recommendations on how a local verification may be undertaken before instruments are implemented into routine clinical practice.

Discussion

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Cite This Study

Collinson et al. (2026) conducted a review in Patients with suspected acute coronary syndrome presenting to acute care settings such as emergency departments requiring rapid risk stratification using high sensitivity cardiac troponin assays. Point of care testing (POC) for high sensitivity cardiac troponin (hs-cTn) vs. Central laboratory hs-cTn assay was evaluated on Sensitivity and negative predictive value (NPV) for non-ST elevation myocardial infarction (NSTEMI) when using high sensitivity cardiac troponin assays in accelerated diagnostic protocols (ADPs) (Sensitivity 97.5-99%, NPV >99.5%). Point of care testing for high sensitivity cardiac troponin in suspected acute coronary syndromes can achieve sensitivity for NSTEMI of 97.5-99% and negative predictive value above 99.5%, comparable to central laboratory assays.

synapsesocial.com/papers/69abc2255af8044f7a4eb7dc https://doi.org/10.1515/cclm-2026-0210

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Considerations and pragmatic strategies for implementation of point of care testing for high sensitivity cardiac troponin into the acute care setting

Key Points

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Considerations and pragmatic strategies for implementation of point of care testing for high sensitivity cardiac troponin into the acute care setting

Key Points

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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