Key result
Point-of-care high-sensitivity troponin reliably rules out acute MI with ~99% negative predictive value.
Why the study?
The diagnostic accuracy of commercially available high-sensitivity cardiac troponin point-of-care devices for rapid rule-out of acute myocardial infarction in emergency department patients with chest pain was unclear.
Do high-sensitivity cardiac troponin point-of-care assays provide accurate diagnostic performance for ruling out acute myocardial infarction in adult patients presenting to the emergency department with chest pain?
Systematic Review (n=10,115)
Do high-sensitivity cardiac troponin point-of-care assays provide accurate diagnostic performance for ruling out acute myocardial infarction in adult patients presenting to the emergency department with chest pain?
High-sensitivity cardiac troponin point-of-care devices are highly reliable for the rapid rule-out of acute myocardial infarction in emergency department patients with chest pain when utilizing very low troponin thresholds upon arrival.
Answers are grounded in this paper and cite their sources.
Supports rapid ED rule-out and discharge for low-risk chest pain; confirms high accuracy of hs-cTn POC assays at very low thresholds.
High-sensitivity cardiac troponin (hs-cTn) assays have significantly enhanced the diagnosis in patients suspected of acute coronary syndrome (ACS). New hs-cTn point-of-care (POC) devices (turnaround time <20 min) may significantly reduce time to diagnosis. We evaluated the diagnostic accuracy of four currently commercially available hs-cTn POC devices to assess their potential for clinical implementation at the emergency department (ED). We conducted a search in PubMed Central on 20 November, 2025. Studies were included if they investigated patients greater than or equal to 18 years presenting with chest pain suggestive of ACS and evaluated commercially available hs-cTn POC devices. Studies had to report diagnostic accuracy [sensitivity, specificity, negative predictive value (NPV), positive predictive value] for the diagnosis of acute myocardial infarction (AMI). Studies were assessed for risk of bias and applicability using the QUADAS-3 tool. We identified 436 articles. The 11 included studies consisted of both derivation and validation studies, including a total of 10 115 patients. The hs-cTn POC assays demonstrated the best diagnostic accuracy when applied as a single-test rule-out upon arrival at the ED, showing the following sensitivity and NPV: Atellica VTLi sensitivity 98.8-100% for troponin less than 4 ng/L (NPV: 99.8-100%) and 100% for troponin less than 7 ng/L (NPV 100%). Pathfast sensitivity 96.3-100% for troponin less than 3 ng/L (NPV: 98.1-100%). i-STAT sensitivity of 99.8% for troponin less than 5 ng/L (NPV: 100%). TriageTrue sensitivity of 100% for troponin less than 3 ng/L (NPV 100%). VTLi, Pathfast, and TriageTrue were also tested using the 99th percentile with a 0 + 1/2/3 h troponin protocol. Reported sensitivities: VTLi 64.8-100%, Pathfast 87% for plasma and 83% for whole blood, and TriageTrue 79.8%. Hs-cTn POC assays are reliable for integration into the diagnostic pathways for patients presenting with chest pain at the ED, mainly when used for rapid rule-out of AMI in patients with very low troponin values upon arrival.
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Daalen et al. (2026) conducted a systematic review in Chest pain suggestive of acute coronary syndrome (n=10,115). High-sensitivity cardiac troponin (hs-cTn) point-of-care (POC) devices was evaluated on Diagnostic accuracy (sensitivity, specificity, NPV, PPV) for acute myocardial infarction. High-sensitivity point-of-care troponin assays reliably rule out acute myocardial infarction upon emergency department arrival, demonstrating sensitivities of 96.3–100% and NPVs of 98.1–100%.
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