Point-of-care high-sensitivity troponin assays: Advancements, clinical applications, and implementation considerations

Abstract

High-sensitivity cardiac troponin (hs-cTn) assays have changed the workflow in emergency departments allowing for rapid allocation of patients with high or low risk of non-ST elevation myocardial infarction. Recently, hs-cTn point-of-care testing (POCT) assays have become available. There are significant expectations that this technology will improve patient flow, reduce overcrowding in emergency departments and improve prehospital investigations for acute coronary syndrome. Measurements of hs-cTn by POCT may also have a role in other health care facilities where hs-cTn measurements are useful but currently unavailable or have long turn-around time and may provide backup instruments for central laboratory platforms in smaller laboratories. This review describes the currently available hs-cTn POCT assays and include an update on recently published clinical data. It outlines benefits of using POCT hs-cTn assays including the possibility of more efficient management of patients with symptoms suggestive of acute coronary syndrome. Additionally, we discuss alternative conditions and clinical and practical scenarios where these assays may become useful. Finally, it highlights the broad spectrum of issues that come along with the implementation of POCT, and suggest the scientific data and practical considerations that should be in place before hs-cTn POCT may be successfully implemented into the daily routine.