Cardiac troponin at the point of care in acute and chronic coronary syndromes

Abstract

High-sensitivity cardiac troponin (hs-cTn) assays are integral to the assessment of patients with acute chest pain where prompt and accurate diagnosis of myocardial infarction enables timely delivery of potentially life-saving treatment. In the Emergency Department, implementation of central laboratory hs-cTn assays has reduced length of stay and unnecessary hospital admission. Recently hs-cTn assays have become available on point-of-care (POC) platforms that have equivalent analytical and diagnostic performance to central laboratory platforms but can deliver results more rapidly to guide decisions in real-time. These assays have the potential to further accelerate care in the Emergency Department and to facilitate the assessment of patients with suspected acute coronary syndromes in pre-hospital settings, primary care and the out-patient clinic. Greater accessibility to testing could broaden the role of hs-cTn to improve the risk stratification of patients with new onset exertional angina and chronic coronary syndromes. Whilst hs-cTn assays are already available for use at the point-of-care, prospective studies are required to determine the clinical and cost-effectiveness of testing in patients with acute and chronic coronary syndromes.

Keywords: cardiovascular disease; macrovascular disease; real‐world evidence; systematic review.

FIGURE 1

Overview of normal sarcomere and release of cardiac troponin following acute myocardial injury.