For a rapid diagnosis of acute myocardial infarction, a sensitive troponin assay is needed in the near-patient testing setting

Abstract

Evaluation of: Collinson P, Goodacre S, Gaze D et al. Very early diagnosis of chest pain by point-of-care testing: comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial. Heart 98(4), 312–318 (2012).

An early diagnosis of myocardial infarction in the emergency setting would be advantageous for both patients and the physicians treating these patients. Guidelines currently recommend serial samples that are drawn at presentation and 6–9 h later to be measured for cardiac troponin to aid in this diagnosis. However, much effort has been directed to decrease the time to make a diagnosis in this setting, and there has been renewed interest in shortening the time between serial measurements as well as the turnaround time for reporting the results. By eliminating the blood sample transit time to the central laboratory, point-of-care testing or near-patient testing can reduce the turnaround time for reporting the results, however this is possibly at the cost of decreased diagnostic performance. In this article, we discuss the recent results from the RATPAC study, which evaluated whether the combination of myoglobin, the MB isoenzyme of creatine kinase (CKMB) and a sensitive troponin assay would be superior to troponin alone.

Keywords::

• 90 minutes
• chest pain
• creatine kinase MB
• diagnosis
• emergency department
• myocardial infarction
• myoglobin
• point-of-care testing
• presentation
• sensitive troponin I

Financial & competing interests disclosure

P Kavsak has received speaker fees, honorarium and/or grant support from the following diagnostic companies that manufacture cardiac troponin assays: Abbott, Beckman Coulter, Ortho Clinical Diagnostics, Randox and Roche. A Worster has received an honorarium for serving on an advisory board and served as an unpaid investigator for Roche Diagnostics. McMaster University has filed a patent application on an early rule-out biomarker panel, with P Kavsak and A Worster listed as inventors on this application. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.