Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report
<b>Background</b>: Thanks to the evolution of laboratory medicine, point-of-care testing (POCT) for troponin levels in the blood (hs-cTn) has been greatly improved in order to quickly diagnose acute myocardial infarction (AMI) with an accuracy similar to standard laboratory tests. The ra...
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2025-01-01
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| Online Access: | https://www.mdpi.com/2075-4418/15/2/220 |
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| author | Cristian Lazzari Sara Montemerani Cosimo Fabrizi Cecilia Sacchi Antoine Belperio Marilena Fantacci Giovanni Sbrana Agostino Ognibene Maurizio Zanobetti Simone Nocentini |
| author_facet | Cristian Lazzari Sara Montemerani Cosimo Fabrizi Cecilia Sacchi Antoine Belperio Marilena Fantacci Giovanni Sbrana Agostino Ognibene Maurizio Zanobetti Simone Nocentini |
| author_sort | Cristian Lazzari |
| collection | DOAJ |
| description | <b>Background</b>: Thanks to the evolution of laboratory medicine, point-of-care testing (POCT) for troponin levels in the blood (hs-cTn) has been greatly improved in order to quickly diagnose acute myocardial infarction (AMI) with an accuracy similar to standard laboratory tests. The rationale of the HEART POCT study is to propose the application of the 0/1 h European Society of Cardiology (ESC) algorithm in the pre-hospital setting using a POCT device (Atellica VTLi). <b>Methods</b>: This is a prospective study comparing patients who underwent pre-hospital point-of-care troponin testing (Atellica VTLi) with a control group that underwent standard hospital-based troponin testing (Elecsys). The primary objectives were to determine if the 0/1 h algorithm of the Atellica VTLi is non-inferior to the standard laboratory method for diagnosing AMI and to analyze rule-out/rule-in times and emergency department (ED) stay times. The secondary objective was to evaluate the feasibility of pre-hospital troponin testing. <b>Results</b>: The Atellica VTLi demonstrated reasonable sensitivity for detecting AMI, with sensitivity increasing from 60% at the first measurement (time 0) to 80% at the second measurement (time 1 h). Both the Atellica VTLi and the Elecsys method showed high negative predictive value (NPV), indicating that a negative troponin result effectively ruled out AMI in most cases. Patients in the Atellica VTLi group experienced significantly shorter times to diagnosis and discharge from the emergency department compared to the control group (Elecsys). This highlights a potential benefit of point-of-care testing: streamlining the diagnostic and treatment processes. <b>Conclusions</b>: POCT allows for rapid troponin measurement, leading to a faster diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). This enables earlier initiation of appropriate treatment, potentially improving patient outcomes and the efficiency of emergency department operations. POCT could be particularly beneficial in pre-hospital settings, enabling faster triage and transportation of patients to appropriate care centers. |
| format | Article |
| id | doaj-art-97c23ce50a5740a38cd58c2a4378bf40 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-97c23ce50a5740a38cd58c2a4378bf402025-01-24T13:29:09ZengMDPI AGDiagnostics2075-44182025-01-0115222010.3390/diagnostics15020220Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary ReportCristian Lazzari0Sara Montemerani1Cosimo Fabrizi2Cecilia Sacchi3Antoine Belperio4Marilena Fantacci5Giovanni Sbrana6Agostino Ognibene7Maurizio Zanobetti8Simone Nocentini9UOC Medicina d’Emergenza Urgenza e Pronto Soccorso Ospedale San Donato di Arezzo, Dipartimento Emergenza Urgenza, Azienda USL Toscana Sud-Est, 52100 Arezzo, ItalyUOC Medicina d’Emergenza Urgenza e Pronto Soccorso Ospedale San Donato di Arezzo, Dipartimento Emergenza Urgenza, Azienda USL Toscana Sud-Est, 52100 Arezzo, ItalyUOC Medicina d’Emergenza Urgenza e Pronto Soccorso Ospedale San Donato di Arezzo, Dipartimento Emergenza Urgenza, Azienda USL Toscana Sud-Est, 52100 Arezzo, ItalyScuola di Specializzazione in Medicina d’Emergenza Urgenza, Università degli Studi di Siena, 53100 Siena, ItalyUOC Emergenza Territoriale 118 Area Provinciale Aretina, Azienda USL Toscana Sud-Est, 52100 Arezzo, ItalyU.O.S.D. Analisi Chimico Cliniche, Ospedale di Nottola, Azienda USL Toscana Sud-Est, 53100 Siena, ItalyUOC Elisoccorso ed Emergenza Territoriale 118 Area Provinciale Grossetana, Azienda USL Toscana Sud-Est, 58100 Grosseto, ItalyUOC Analisi Chimico Cliniche, Ospedale San donato di Arezzo, Azienda USL Toscana Sud-Est, 52100 Arezzo, ItalyUOC Medicina d’Emergenza Urgenza e Pronto Soccorso Ospedale San Donato di Arezzo, Dipartimento Emergenza Urgenza, Azienda USL Toscana Sud-Est, 52100 Arezzo, ItalyUOC Emergenza Territoriale 118 Area Provinciale Aretina, Azienda USL Toscana Sud-Est, 52100 Arezzo, Italy<b>Background</b>: Thanks to the evolution of laboratory medicine, point-of-care testing (POCT) for troponin levels in the blood (hs-cTn) has been greatly improved in order to quickly diagnose acute myocardial infarction (AMI) with an accuracy similar to standard laboratory tests. The rationale of the HEART POCT study is to propose the application of the 0/1 h European Society of Cardiology (ESC) algorithm in the pre-hospital setting using a POCT device (Atellica VTLi). <b>Methods</b>: This is a prospective study comparing patients who underwent pre-hospital point-of-care troponin testing (Atellica VTLi) with a control group that underwent standard hospital-based troponin testing (Elecsys). The primary objectives were to determine if the 0/1 h algorithm of the Atellica VTLi is non-inferior to the standard laboratory method for diagnosing AMI and to analyze rule-out/rule-in times and emergency department (ED) stay times. The secondary objective was to evaluate the feasibility of pre-hospital troponin testing. <b>Results</b>: The Atellica VTLi demonstrated reasonable sensitivity for detecting AMI, with sensitivity increasing from 60% at the first measurement (time 0) to 80% at the second measurement (time 1 h). Both the Atellica VTLi and the Elecsys method showed high negative predictive value (NPV), indicating that a negative troponin result effectively ruled out AMI in most cases. Patients in the Atellica VTLi group experienced significantly shorter times to diagnosis and discharge from the emergency department compared to the control group (Elecsys). This highlights a potential benefit of point-of-care testing: streamlining the diagnostic and treatment processes. <b>Conclusions</b>: POCT allows for rapid troponin measurement, leading to a faster diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). This enables earlier initiation of appropriate treatment, potentially improving patient outcomes and the efficiency of emergency department operations. POCT could be particularly beneficial in pre-hospital settings, enabling faster triage and transportation of patients to appropriate care centers.https://www.mdpi.com/2075-4418/15/2/220chest painacute myocardial infarction (AMI)acute coronary syndromes (ACSs)point-of-care testing (POCT)high-sensitivity cardiac troponin (hs-cTn)non-ST-segment elevation myocardial infarction (NSTEMI) |
| spellingShingle | Cristian Lazzari Sara Montemerani Cosimo Fabrizi Cecilia Sacchi Antoine Belperio Marilena Fantacci Giovanni Sbrana Agostino Ognibene Maurizio Zanobetti Simone Nocentini Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report Diagnostics chest pain acute myocardial infarction (AMI) acute coronary syndromes (ACSs) point-of-care testing (POCT) high-sensitivity cardiac troponin (hs-cTn) non-ST-segment elevation myocardial infarction (NSTEMI) |
| title | Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report |
| title_full | Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report |
| title_fullStr | Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report |
| title_full_unstemmed | Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report |
| title_short | Pre-Hospital Point-of-Care Troponin: Is It Possible to Anticipate the Diagnosis? A Preliminary Report |
| title_sort | pre hospital point of care troponin is it possible to anticipate the diagnosis a preliminary report |
| topic | chest pain acute myocardial infarction (AMI) acute coronary syndromes (ACSs) point-of-care testing (POCT) high-sensitivity cardiac troponin (hs-cTn) non-ST-segment elevation myocardial infarction (NSTEMI) |
| url | https://www.mdpi.com/2075-4418/15/2/220 |
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