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Determination of a whole-blood single-test low-risk threshold for a point-of-care high-sensitivity troponin assay
  1. John W Pickering1,2,
  2. Laura Hamill3,
  3. Sally Aldous4,
  4. Laura Joyce2,5,
  5. R Alex Stothart2,
  6. Otis Williams2,
  7. Christopher M Florkowski6,
  8. Martin Than1
  1. 1 Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
  2. 2 Emergency Department, Christchurch Hospital, Christchurch, New Zealand
  3. 3 Pegasus Health 24 Hour Surgery Ltd, Christchurch, New Zealand
  4. 4 Cardiology, Christchurch Hospital, Christchurch, New Zealand
  5. 5 Department of Surgery and Critical Care, University of Otago Christchurch, Christchurch, New Zealand
  6. 6 Te Whatu Ora Health New Zealand Canterbury Health Laboratories, Christchurch, New Zealand
  1. Correspondence to Dr Martin Than, Emergency Department, Christchurch Hospital, Christchurch, Canterbury, New Zealand; martin{at}thanstedman.onmicrosoft.com

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High-sensitivity troponin (hsTn) is used with ECG and clinical evaluation to stratify patients attending ED as low risk for acute myocardial infarctions (AMI). Diagnostic pathways incorporate a single test threshold for stratification with these assays. The Siemens Atellica VTLi Point-Of-Care-hsTnI assay (POC-hsTnI) has an 8 min turn-around which may expedite decision-making. Although a single-test low-risk (‘rule-out’) threshold for this assay has been reported,1 it was desirable to determine a threshold specifically for New Zealand ED settings and intended end-users.

From 3 November 2022 to 28 May 2023, hsTnI was measured by POC-hsTnI and laboratory (Beckman Coulter DXI800) assays from one venous blood draw into a single lithium heparin tube. The whole-blood limit of detection (LoD) of the POC-hsTnI is 1.6 ng/L, and the 10% and 20% coefficient of variations (CVs) are 8.9 ng/L and 3.7 ng/L.2 3 The Beckman assay plasma LoD and 20% CV are 0–2.3 ng/L, 10% CV 5.6 ng/L and 99th percentiles 19.8 ng/L (males) and 11.6 ng/L (females).4 Inclusions were adults attending Christchurch ED investigated for possible AMI (including ST-elevation myocardial infarction). POC testing depended …

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Footnotes

  • Handling editor Richard Body

  • X @laurajoycenz

  • Contributors JP, MT and LJ provided scientific advice and authorship. LH, SA and CMF provided scientific analysis and advice. RAS and OW collected and collated data.

  • Funding Health Research Council of New Zealand grant 19-234. Siemens Healthineers provided the assay kits free of charge and funding for the adjudicator.

  • 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.