Key result
Point-of-care troponin I matches laboratory troponin accuracy for ACS with faster turnaround.
Why the study?
Conventional laboratory troponin may delay the diagnosis and management of acute chest pain and ACS, and data describing the diagnostic performance of point-of-care testing (POCT) troponin I (TnI) in the Asian population are sparse.
Does point-of-care troponin I testing improve turnaround time while maintaining comparable diagnostic accuracy for acute coronary syndrome compared to conventional laboratory troponin T in patients presenting with acute chest pain?
Observational (n=996)
No
Does point-of-care troponin I testing improve turnaround time while maintaining comparable diagnostic accuracy for acute coronary syndrome compared to conventional laboratory troponin T in patients presenting with acute chest pain?
In an Asian tertiary care cohort presenting with acute chest pain, point-of-care troponin I testing dramatically reduced turnaround time from 145 to 10 minutes while maintaining comparable diagnostic accuracy and a 98.8% negative predictive value (<4 ng/L) for acute coronary syndrome compared to conventional laboratory troponin T.
Answers are grounded in this paper and cite their sources.
May support faster ACS rule-out in chest pain; leaves open need for prospective trials to confirm safety and outcomes.
Background Chest pain is a common complaint and encompasses potentially life-threatening pathologies including acute coronary syndrome (ACS), but its diagnosis and management might be delayed by relying on conventional laboratory troponin. Point-of-care-testing (POCT) troponin I (TnI) assays may represent an emerging option to facilitate rapid diagnosis and expedite interventional measures. There is a paucity of data describing the diagnostic performance of POCT TnI, particularly in the Asian population. Purpose To evaluate the association between POCT TnI and conventional laboratory testing as well as clinical outcomes. Methods All patients presenting with acute chest pain to a hospital (a tertiary referral center in Hong Kong, China serving a population of 530,000) who underwent POCT TnI testing from 31/07/2023 to 30/06/2024 were included. The turnaround time for POCT TnI assays were compared against that of conventional laboratory troponin T (TnT). Cut-offs used for elevated POCT include 4ng/L (1) and 22.9ng/L (99th percentile). It was compared against final diagnoses including ACS. We compared the area under curve for POCT TnI vs conventional TnT in association with ACS diagnosis. The association between elevated TnI and modified HEART (mHEART) score as well as ACS diagnosis were evaluated. Results A total of 996 patients (mean age 68years, 48% female) underwent POCT TnI. The median (interquartile range [IQR]) turnaround time were 10 (8–14) minutes vs 145 (121–169) minutes for POCT TnI and conventional TnT, respectively (P<0.001). The area under curve (95%CI) for POCT TnI and conventional TnT in association with ACS diagnosis were 0.879 (0.827–0.932) and 0.898 (0.863–0.93s), respectively (Fig.), and the difference was not significant (P=0.280). POCT TnI with level <4ng/L has a negative predictive value (NPV) of 98.8 (95% confidence interval [CI] 97.6 – 100.0) % for ACS diagnosis, comparable to that of TnT (98.9, 95% CI 98.0-100.0). The median (IQR) of mHEART score for patients with and without elevated POCT TnI were 6 (5–8) and 3 (2–4), respectively (P<0.001). When POCT TnI ≥ 99th percentile was combined with mHEART score ≥7, the positive predictive value for ACS diagnosis was 96.8% (95% CI 97.4-99.5). Conclusion(s) This is the first study evaluating utilization of POCT TnI testing in a large tertiary care centre in the Asia-Pacific region. Notably, a single measurement of POCT TnI<4ng/L has achieved 98.8% NPV for ACS. Our results highlight that POCT TnI testing represents an emerging, rapid, and readily available test that may facilitate diagnosis and management of patients with chest pain. The scope of implementing POCT TnI needs to be broadened.
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Li et al. (2026) conducted an observational in Acute chest pain / suspected acute coronary syndrome (ACS) (n=996). Point-of-care testing (POCT) troponin I (TnI) assay vs. Conventional laboratory troponin T (TnT) was evaluated on Diagnostic accuracy (AUC) for acute coronary syndrome (ACS) diagnosis (AUC 0.879 vs 0.898, 95% CI 0.827-0.932, p=0.280). Point-of-care troponin I showed comparable ACS diagnostic accuracy to lab troponin T (AUC 0.879 vs 0.898, P=0.280; NPV 98.8% at <4ng/L) with faster turnaround (10 vs 145 min, P<0.001).
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