The effectiveness of point-of-care testing for the detection oftroponin in patients with acute coronary syndromesOzturk Ayse11University College Leuven-Limburg (HERESTRAAT49, 3000 LEUVEN, BELGIUM)SummaryBackground. Acute coronary syndrome (ACS) encompasses thespectrum from unstable angina to non-ST-segment elevation myocardial infraction(STEMI) and non-ST-segment elevation myocardial infraction (NSTEMI). 2 Theseconditions can be triggered by several causes, mainly because of atherosclerosisand thrombosis, where the blood flow to the heart muscle is decreased.
1 Thesymptoms prompting the suspicion of ACS include chest pain, neck or armdiscomfort, dyspnea, epigastric pain,… 8 ACS is amedical emergency that requires quick diagnosis and therapy. 3 Patients with STEMIshow an elevated ST-segment on an electrocardiogram (ECG). Others show noST-elevation and are mainly diagnosed with unstable angina or NSTEMI. Thedistinction between unstable angina and NSTEMI is based on the finding ofelevated cardiac markers. 6Troponin iscomposed by three peptides: troponin T (TnT), a regulatory protein totropomyosin; troponin I (TnI), an inhibitor of actomyosin ATPase activity; andtroponin C (TnC), the calcium-binding subunit of the troponin complex. Differentisoforms are found in cardiac and skeletal muscle for both TnT and TnI. Thecardiac forms are called cardiac TnT (cTnT) and cardiac TnI (cTnI).
Increased amountsof troponins are released into the bloodstream when an damage is done to themyocardium. After a myocardial infraction, cTnI and cTnT begin to increase andstay elevated for a few days. These parameters can be measured by point-of-caretesting (POCT). 1, 4, 5 Different studies have reviewed the use of POCT for the detection of troponinand concluded that this method has lots of advantages: first of all, rapid testresults are obtained by reducing the time spent in test ordering, specimen transportto a laboratory and data processing. Therefore diagnosis and treatment can be implementedslightly earlier. Secondly, there have been documented improvements such asdecreased emergency room (ER) and hospital length-of-stay (LOS), decreasedoverall cost following these technologies.
1, 4, 5, 6, 7, 8Although all consulted articles share the same opinion on the advantagesof POCT for the detection of troponin, the opinion on its effectiveness in thediagnosis of ACS is divided. Some disapprove its use because of the lack ofsensitivity for screening and the accuracy of the results. Others do approveand recommend the use of POCT for troponin because it increases the ability todiagnose and treat the disease. 1, 4, 5, 6, 7, 8Purpose. Theaim of this study is to analyse the accuracy of POCT for the detection of troponin,using blood samples of patients with acute coronary syndromes.