What is the diagnostic accuracy of different high sensitive point-of-care troponin assays for the assessments of patients presenting with chest pain at the emergency department?

Background 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, with a turnaround time <20 minutes, may reduce time to diagnosis compared to central laboratory testing. However, it remains unclear whether the diagnostic accuracy of hs-cTn POC assays is comparable to that of central laboratory assays. Purpose We evaluated the diagnostic accuracy of four hs-cTn POC assays to assess their potential for clinical implementation at the emergency department (ED). Methods We conducted a search in PubMed Central on 20 November 2025. Studies were eligible for inclusion if they investigated adult patients (≥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 (PPV)) as an outcome measure. The search strategy identified 436 articles, of which 11 were included in this systematic review, describing four currently commercially available hs-cTn POC devices. Results The described hs-cTn POC assays demonstrated the best diagnostic accuracy when applied as a single test rule-out upon arrival at the ED. The Atellica VTLi demonstrated a sensitivity > 98.8% for troponin values <7 ng/l, and a specificity of 97.7% for troponin values > 52 ng/l. The i-STAT assay showed a sensitivity of 99.8% for troponin values <5 ng/l and a specificity 96.4% at troponin values > 25 ng/l. The Pathfast achieved a sensitivity > 99.1% for troponin values <4 ng/l and a specificity > 96.4% for troponin values ≥ 90 ng/l. VTLI, Pathfast and TriageTrue were also tested using the 99th percentile with a 0+1/2/3 hour troponin protocol, reporting sensitivities of 64.8-100.0% and specificities of 85.8-96.0%. Conclusion This systematic review indicates that hs-cTn POC assays are reliable for integration in the diagnostic pathways for patients presenting with chest pain at the ED, mainly when used for rapid rule out of ACS in patients with very low troponin values upon arrival.