Point-of-care versus central laboratory troponin testing for diagnosis of acute coronary syndrome in acute care settings a review of the clinical and economic evidence

Summary: Acute coronary syndrome (ACS) refers to any group of symptoms attributed to the obstruction of the coronary arteries, and clinical presentations include ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA). Myocardial infarction (MI), which is defined by the presence of myocardial necrosis in combination with clinical evidence of myocardial ischemia, is caused by a perfusion imbalance between supply and demand within the coronary arteries as a result of an acute thrombotic process. In the past, biochemical markers of cardiac damage caused by myocardial ischemia have included aspartate transaminase, plasma creatine kinase, lactate dehydrogenase, and specific isoenzymes of both creatine kinase and lactate dehydrogenase. However, these biomarkers and developed assays have suffered from a lack of specificity. In 2000, the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) established cardiac troponin as the biomarker of choice in the diagnosis of MI. Troponin can typically be detected approximately two to four hours after the onset of myocardial injury. The purpose of this review is to compare the diagnostic test performance, clinical effectiveness, and cost-effectiveness of central laboratory troponin and point-of-care troponin assays, specifically for cTnI and cTnT biomarkers.