Key result
Point-of-care troponin shows poor ~47% sensitivity for detecting initial acute myocardial infarction.
Why the study?
Point-of-care cardiac troponin testing allows rapid bedside evaluation but is less sensitive than high-sensitivity assays, necessitating assessment of its diagnostic accuracy for AMI.
Does point-of-care cardiac troponin testing accurately diagnose acute myocardial infarction in adult patients presenting with chest pain?
Meta-Analysis (n=23,841)
Does point-of-care cardiac troponin testing accurately diagnose acute myocardial infarction in adult patients presenting with chest pain?
Point-of-care troponin testing demonstrates robust specificity (~90%) for ruling in acute myocardial infarction but limited sensitivity (<50%), highlighting that a negative result cannot safely rule out the condition.
Initial point-of-care troponin cannot reliably exclude AMI; confirms need for serial testing or central-lab confirmation.
Background: Point-of-care (POC) cardiac troponin testing, although less sensitive than high-sensitivity cardiac troponin assays, allows for rapid bedside evaluation. This study assessed the diagnostic performance of POC troponin tests for both ruling in and ruling out acute myocardial infarction (AMI) at the time of patient presentation. Methods and Results: In accordance with PRISMA-DTA guidelines, we conducted a systematic review and meta-analysis using PubMed, Web of Science, and the Cochrane Library from inception through June 17, 2023. We included all studies evaluating the diagnostic accuracy of POC troponin assays for identifying AMI among adult patients. Among the 551 studies initially screened, 6 met the eligibility criteria for inclusion. A meta-analysis of diagnostic accuracy based on these 6 observational datasets demonstrated pooled sensitivity and specificity values of 47% (95% confidence interval (CI) 45-49%) and 90% (95% CI 89-90%), respectively, for AMI detection. In a subgroup meta-analysis of non-ST-segment elevation MI using 4 observational datasets, the pooled sensitivity and specificity were 48% (95% CI 45-50%) and 89% (95% CI 89-90%), respectively. Conclusions: These findings emphasize that the clinical application of POC troponin assays in AMI diagnosis must consider the test's robust specificity (≈90%) alongside its limited sensitivity (<50%).
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Arai et al. (2025) conducted a meta-analysis in Acute myocardial infarction (suspected) (n=23,841). Point-of-care (POC) cardiac troponin testing vs. Reference standard was evaluated on Diagnostic accuracy (pooled sensitivity and specificity) for acute myocardial infarction (Pooled sensitivity 47% and specificity 90%, 95% CI 45-49). Point-of-care cardiac troponin testing demonstrated a low pooled sensitivity of 47% and high specificity of 90% for detecting acute myocardial infarction at initial presentation.
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