Point-of-Care Testing for Conventional Cardiac Markers

There have been significant advances in the management of patients with acute coronary syndromes. Optimum therapy is dependent on rapid diagnosis and subsequent treatment. As the diagnosis of acute myocardial infarction (AMI) is now predicated on the presence of an increase concentration of cardiac markers in blood, there is interest in using point-of-care testing (POCT). In research studies, the implementation of POCT for cardiac markers reduced turnaround times by an average of 79% over central laboratory testing, sufficient to meet current clinical guidelines. Faster reporting of results may have an impact on reducing emergency department and hospital lengths of stay. For diagnosis of AMI, POCT assays have equivalent diagnostic performance to central laboratory testing. There is a trend towards eliminating the need for creatine kinase-MB isoenzyme and myoglobin in favor of troponin alone (T or I). POCT can also be used for risk stratification, i.e., the prediction of future short-term adverse cardiac events. However, the sensitivity and precision of both POCT and central laboratory assays must be improved, so that lower cutoff concentrations can be used (ideally at the 99th percentile of a healthy population with a precision of ≤10%). This will result in the detection of more patients with minor increases in troponin who are at high cardiovascular risk.