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  • High-sensitivity troponin testing at the point of care for the diagnosis of myocardial infarction: a prospective emergency department clinical evaluation

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Research letter
High-sensitivity troponin testing at the point of care for the diagnosis of myocardial infarction: a prospective emergency department clinical evaluation
  1. Jemima May Curran1,
  2. Aleksandra Mergo2,
  3. Sarah White1,
  4. Bernard L Croal3,
  5. Jamie G Cooper1
  1. 1 Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
  2. 2 University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK
  3. 3 Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
  1. Correspondence to Dr Jemima May Curran, Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK; jemima.curran2{at}nhs.scot

https://doi.org/10.1136/emermed-2023-213633

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    In the ED, laboratory high-sensitivity cardiac troponin (hs-cTn) tests facilitate ‘rule-out’ of myocardial infarction (MI).1 Contemporary point-of-care (POC) troponin tests have inferior analytical sensitivity,2 preventing rapid ‘rule-out’ strategies in near-patient settings. The new Siemens Atellica VTLi POC test meets hs-cTn criteria.3

    Between June and September 2022, adult ED patients (≥16 years) with symptoms suspicious for MI and no ST-segment elevation on ECG were eligible for inclusion if staff trained on the POC instrument were available. Simultaneously, blood was taken for near-patient testing with the VTLi POC hs-cTnI assay (limit of detection (LOD) of 1.2 ng/L, sex-specific 99th percentile upper reference limits (URLs) of 18 ng/L (female) and 27 ng/L (male), and an optimised ‘rule-out’ threshold of <4 ng/L)3 and for laboratory testing with the Abbott Alinity hs-cTnI assay (LOD of 1.6 ng/L, URLs of 16 ng/L (female) and 34 ng/L (male), and an optimised ‘rule-out’ threshold of <5 ng/L),4 the standard-of-care assay for this evaluation. Patients with no result for either assay or who presented ≤2 hours from symptom onset were excluded and POC results were not available to clinicians.

    The end-point was an index presentation type 1 MI or cardiac death, independently adjudicated by two investigators (blinded to POC results) according to the fourth universal definition of MI. …

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    Footnotes

    • Handling editor Richard Body

    • X @JamieCooperEM

    • Presented at These results were presented at the RCEM Scotland EM Clinical Conference, Glasgow, 10 May 2023.

    • Contributors JGC and BLC conceived the study and its design. JMC, AM, SMW, BLC and JGC acquired the data, JMC and JGC performed the analysis and JMC, BLC and JGC interpreted the data. JMC and JGC drafted the manuscript and all authors reviewed the manuscript critically for intellectually important content and provided their final approval of the version to be submitted. All authors are accountable for the work.

    • Funding Siemens Healthineers provided the Siemens Atellica VTLi point-of-care instrument and troponin test cartridges but had no input into the design or administration of the evaluation. JMC received support from the NHS Grampian Endowment Fund and JGC is supported by NHS Research Scotland.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.