Highly Reliable One-Pot SERS Aptasensor for Rapid Cardiac Troponin I Detection in Acute Myocardial Infarction

Rapid clinical decision-making for acute myocardial infarction (AMI) relies on the timely and precise assessment of cardiac biomarkers. However, detecting cardiac troponin I (cTnI), as the gold-standard biomarker for AMI, with both laboratory-grade sensitivity and rapid clinical turnaround remains a formidable challenge in point-of-care (POC) settings. To address this, we develop a one-pot surface-enhanced Raman scattering (SERS) aptasensor that integrates aptamer-mediated cTnI recognition, catalytic hairpin assembly (CHA) amplification, and plasmonic hotspot assembly. The assay supports two kinetic operating modes within the same assay: a 60-min high-sensitivity mode with a serum limit of detection (LOD) of 53.58 fg/mL and a 20-min rapid-triage mode with an LOD of 14.25 pg/mL, below the clinical decision threshold of 40 pg/mL. In a cohort of 100 clinical serum samples, the bootstrap optimism-corrected diagnostic accuracy was 91.3% for the SERS aptasensor, significantly outperforming conventional ELISA (77.8%). In a subset of 94 subjects with available routine cTnT results, the SERS-cTnI assay achieved an area under the receiver operating characteristic curve (AUC) of 0.988, comparable to that of the hospital’s routine chemiluminescence cTnT assay (0.976), supporting its potential as a complementary diagnostic tool for cTnI-based AMI assessment. Furthermore, compatibility with a handheld Raman spectrometer was evaluated in an independent validation cohort (n = 36), achieving 97.2% accuracy using only 4 μL of serum within 20 min following serum preparation. This reliable one-pot SERS platform bridges ultra-sensitive detection and rapid portable readout, holding promise as a potential tool for future decentralized cardiovascular POC diagnostics.