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Three-month outcome of patients with suspected acute coronary syndrome using point-of-care cardiac troponin-T testing compared with laboratory-based cardiac troponin-T testing: a randomised trial
  1. Stephen Edward Asha1,2,
  2. Andrew Cooke1,
  3. Elizabeth Walter1,
  4. James Weaver2,3
  1. 1Emergency Department, St George Hospital, Sydney, New South Wales, Australia
  2. 2Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Cardiology Department, St George Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Stephen Edward Asha, Emergency Department, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia; stephen.asha{at}sesiahs.health.nsw.gov.au

Abstract

Objective The aim of this randomised trial was to determine clinical outcomes in patients suspected of an acute coronary syndrome (ACS) who had cardiac troponin-T measured by point-of-care (POC) compared with laboratory-based cardiac troponin-T testing. A secondary aim was to describe the correlation between the two troponin assays.

Methods Adults suspected of ACS were allocated to have troponin processed by POC or laboratory analyser. The primary outcome was a composite of acute myocardial infarction, coronary revascularisation, cardiac arrest and mortality at 3 months. Paired troponins taken on participants allocated to POC were used to determine correlation between troponin values obtained from laboratory and POC analysers.

Results There were 452 participants. 30 (13.1%) of 229 participants allocated to POC had at least one primary outcome event compared with 29 (13.0%) of 223 allocated to laboratory testing, a difference of 0.1% (95% CI −6.2% to 6.4%, p=0.98). Of 215 available paired troponins results, both analysers gave congruent results in 196 (91%) cases. The POC troponin was negative when the laboratory sample was positive in 16 (7%) cases. The POC troponin was positive when the laboratory sample was negative in 3 (1%) samples. Passing–Bablok regression analysis demonstrated both a constant and proportional difference between the two analytic methods.

Conclusions Among patients suspected of an ACS, we found no evidence for a difference in adverse outcome when POC troponin was used in comparison with laboratory troponin. Due to the small sample size, an absolute difference of up to 6% in adverse outcome is possible.

Trial registration number ANZCTR#12612000319875.

  • cardiac care, acute coronary syndrome
  • cardiac care, diagnosis

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