Key result
High-sensitivity point-of-care troponin algorithms yield 99.9% NPV for ruling out AMI.
Why the study?
To evaluate the diagnostic accuracy of high-sensitivity point-of-care cardiac troponin algorithms for rule-out and rule-in of AMI in emergency departments.
Do serial high-sensitivity point-of-care cardiac troponin algorithms accurately rule-out and rule-in acute myocardial infarction in adults presenting to the emergency department?
Meta-Analysis (n=9,384)
Do serial high-sensitivity point-of-care cardiac troponin algorithms accurately rule-out and rule-in acute myocardial infarction in adults presenting to the emergency department?
High-sensitivity point-of-care troponin algorithms (0-hour/1-hour and 0-hour/2-hour) provide high diagnostic accuracy for the rapid rule-out and rule-in of acute myocardial infarction in the emergency department.
Supports hs-POC troponin algorithms for rapid AMI rule-out in EDs; extends lab-based evidence to point-of-care platforms.
Purpose To evaluate the diagnostic accuracy of high-sensitivity point-of-care (hs-POC) cardiac troponin algorithms for rule-out and rule-in of acute myocardial infarction (AMI) in emergency departments. Methods This PROSPERO-registered systematic review (CRD420251170970) searched MEDLINE, CENTRAL and trial registries (2005–2025) for studies evaluating serial hs-POC troponin testing (0 hour/1 hour or 0 hour/2 hour algorithms) in adults with suspected AMI. Primary outcomes were sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Results Eight studies (19 datasets; 9384 patients; 1157 AMI cases) evaluated four hs-POC platforms: Siemens Atellica VTLi, PHC Pathfast, QuidelOrtho TriageTrue and BioMérieux SPINCHIP. Rule-out algorithms achieved pooled sensitivity 98.0% (95% CI 96.0% to 99.0%) and NPV 99.9% at an assumed AMI prevalence of 10%, with no additional missed AMI events reported during follow-up among patients classified as rule-out. Rule-in algorithms achieved specificity 96.0% (94.0% to 97.0%) and PPV 68.5% assuming a disease prevalence of 10%. Complex multiparametric algorithms showed higher pooled sensitivity (99.3%, I²=0%) than simple cut-off approaches (96.9%). The 0 hour/1 hour protocol showed similar diagnostic accuracy to 0 hour/2 hour while potentially allowing clinical decisions approximately 1 hour earlier. All four evaluated platforms achieved rule-out sensitivities ≥97%. All evaluated platforms met contemporary high-sensitivity analytical criteria and reported turnaround times of 8–17 min enabling rapid clinical decision-making and high diagnostic accuracy for both rule-out and rule-in applications. Overall risk of bias was low in 75% of datasets. Conclusions hs-POC troponin algorithms demonstrated high diagnostic accuracy for both rule-out and rule-in of AMI. Validated serial testing pathways, including 0 hour/1 hour and 0 hour/2 hour strategies, showed favourable diagnostic performance across evaluated platforms. Further implementation studies are needed to define their impact on emergency department workflow and patient outcomes. PROSPERO registration number CRD420251170970.
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Capodifoglio et al. (2026) conducted a meta-analysis in acute myocardial infarction (n=9,384). High-sensitivity point-of-care (hs-POC) cardiac troponin algorithms was evaluated on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) (pooled sensitivity 98.0%, 95% CI 96.0 to 99.0). High-sensitivity point-of-care troponin algorithms demonstrated high diagnostic accuracy for rule-out of AMI, achieving a pooled sensitivity of 98.0% (95% CI 96.0-99.0%) and NPV of 99.9%.
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