Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-30T23:34:32.511Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnostic Performance of Prehospital Point-of-Care Troponin Tests to Rule Out Acute Myocardial Infarction: A Systematic Review

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  09 July 2020

Abdulrhman Alghamdi Open the ORCID record for Abdulrhman Alghamdi [Opens in a new window] ,
Ahmed Alotaibi ,
Meshal Alharbi ,
Charles Reynard  and
Richard Body
Abdulrhman Alghamdi*
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi
Ahmed Alotaibi
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi
Meshal Alharbi
Affiliation:
College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi Division of Cardiovascular Sciences, University of Leicester, Leicestershire, UK
Charles Reynard
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
Richard Body
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
*
Correspondence: Abdulrhman Alghamdi, MSc, Division of Cardiovascular Sciences, The University of Manchester, 46 Grafton Street, Manchester, M13 9PL, United Kingdom, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Chest pain is one of the most common reasons for 999 calls and transfers to the emergency department (ED). In these patients, acute myocardial infarction (AMI) is often the diagnosis that clinicians are seeking to exclude. However, only a minority of those patients have AMI, causing a substantial financial burden to health services. Cardiac troponin (cTn) is the reference standard biomarker for the diagnosis of AMI. Several commercially available point-of-care (POC) cTn assays are portable and could feasibly be used in an ambulance. The aim of this paper is to systematically review existing evidence for the use of POC cTn assays in the prehospital setting to rule out AMI.

Methods:

A systematic search was conducted on EMBASE, MEDLINE, and CINAHL Plus databases, reference lists, and relevant grey literature, including combinations of the relevant terms. Papers published in English language since the year 2000 were eligible for inclusion. A narrative synthesis of the evidence was then undertaken.

Results:

The initial search and cross-referencing revealed a total of 350 papers, of which 243 were excluded. Seven papers were included in the systematic literature review.

Conclusion:

Current evidence does not support the use of POC troponin assays to exclude AMI due to issues with diagnostic accuracy and insufficient high-quality evidence.

Keywords

biomarkerschest painmyocardial infarctionparamedic
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 567 - 573
Copyright
© World Association for Disaster and Emergency Medicine 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Collinson, PO. Evaluating new diagnostic and prognostic biomarkers in cardiovascular disease. Heart. 2013;99(11):757–758.CrossRefGoogle ScholarPubMed
Goodacre, S, Cross, E, Arnold, J, Angelini, K, Capewell, S, Nicholl, J. The health care burden of acute chest pain. Heart. 2005;91(2):229–230.CrossRefGoogle ScholarPubMed
Thygesen, K, Alpert, JS, Jaffe, AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–2567.CrossRefGoogle ScholarPubMed
Thygesen, K, Alpert, JS, Jaffe, AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–2264.CrossRefGoogle Scholar
Whiting, PF, Rutjes, AW, Westwood, ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–536.CrossRefGoogle ScholarPubMed
Sorensen, JT, Terkelsen, CJ, Steengaard, C, et al. Prehospital troponin T testing in the diagnosis and triage of patients with suspected acute myocardial infarction. Am J Cardiol. 2011;107(10):1436–1440.CrossRefGoogle ScholarPubMed
Rasmussen, MB, Stengaard, C, Sorensen, JT, et al. Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2017;8(4):299–308.CrossRefGoogle ScholarPubMed
Stengaard, C, Sorensen, JT, Ladefoged, SA, et al. Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction. Am J Cardiol. 2013;112(9):1361–1366.CrossRefGoogle ScholarPubMed
Ezekowitz, JA, Welsh, RC, Weiss, D, et al. Providing rapid out of hospital acute cardiovascular treatment 4 (PROACT-4). J Am Heart Assoc. 2015;4(12):e002859.CrossRefGoogle Scholar
Ezekowitz, JA, Welsh, RC, Gubbels, C, et al. Providing rapid out of hospital acute cardiovascular treatment 3 (PROACT-3). Can J Cardiol. 2014;30(10):1208–1215.CrossRefGoogle Scholar
Di Serio, F, Lovero, R, Leone, M, et al. Integration between the tele-cardiology unit and the central laboratory: methodological and clinical evaluation of point-of-care testing cardiac marker in the ambulance. Clin Chem Lab Med. 2006;44(6):768–773.CrossRefGoogle ScholarPubMed
Stopyra, JP, Snavely, AC, Scheidler, JF, et al. Point-of-care troponin testing during ambulance transport to detect acute myocardial infarction. Prehosp Emerg Care. 2020. Epub ahead of print.Google ScholarPubMed
Svensson, L, Isaksson, L, Axelsson, C, Nordlander, R, Herlitz, J. Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome. Coron Artery Dis. 2003;14(3):225–231.CrossRefGoogle ScholarPubMed
Ting, HH, Krumholz, HM, Bradley, EH, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation. 2008;118(10):1066–1079.CrossRefGoogle ScholarPubMed
Campo Dell’ Orto, M, Hamm, C, Liebetrau, C, et al. Telemetry-assisted early detection of STEMI in patients with atypical symptoms by paramedic-performed 12-lead ECG with subsequent cardiological analysis. Eur J Emerg Med. 2017;24(4):272–276.CrossRefGoogle ScholarPubMed
Pedersen, CK, Stengaard, C, Friesgaard, K, et al. Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2019;27(1):84.CrossRefGoogle ScholarPubMed
Svensson, L, Axelsson, C, Nordlander, R, Herlitz, J. Prognostic value of biochemical markers, 12-lead ECG and patient characteristics amongst patients calling for an ambulance due to a suspected acute coronary syndrome. J Intern Med. 2004;255(4):469–477.CrossRefGoogle ScholarPubMed
Svensson, L, Axelsson, C, Nordlander, R, Herlitz, J. Elevation of biochemical markers for myocardial damage prior to hospital admission in patients with acute chest pain or other symptoms raising suspicion of acute coronary syndrome. J Intern Med. 2003;253(3):311–319.CrossRefGoogle ScholarPubMed
Venturini, JM, Stake, CE, Cichon, ME. Prehospital point-of-care testing for troponin: are the results reliable? Prehosp Emerg Care. 2013;17(1):88–91.CrossRefGoogle ScholarPubMed
Ecollan, P, Collet, JP, Boon, G, et al. Prehospital detection of acute myocardial infarction with ultra-rapid human fatty acid-binding protein (H-FABP) immunoassay. Int J Cardiol. 2007;119(3):349–354.CrossRefGoogle Scholar
Slagman, A, Searle, J, Muller, C, Mockel, M. Temporal release pattern of copeptin and troponin T in patients with suspected acute coronary syndrome and spontaneous acute myocardial infarction. Clin Chem. 2015;61(10):1273–1282.CrossRefGoogle ScholarPubMed
Ali, D, Fokkert, MJ, Slingerland, RJ, et al. Feasibility of prehospital chest pain triage at home or in the ambulance by paramedics using the HEART score based upon a single high-sensitive troponin T analysis. Eur Heart J. 2013;34(suppl_1):P4051.CrossRefGoogle Scholar
Stengaard, C, Sørensen, JT, Ladefoged, SA, et al. The potential of optimizing prehospital triage of patients with suspected acute myocardial infarction using high-sensitivity cardiac troponin T and copeptin. Biomarkers. 2017;22(3-4):351–360.CrossRefGoogle ScholarPubMed
Ishak, M, Ali, D, Fokkert, MJ, et al. Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (Famous Triage): ruling out a myocardial infarction at home with the modified HEART score. Eur Heart J Acute Cardiovasc Care. 2017;7(2):102–110.CrossRefGoogle Scholar
Nehme, Z, Boyle, MJ, Brown, T. Diagnostic accuracy of prehospital clinical prediction models to identify short-term outcomes in patients with acute coronary syndromes: a systematic review. J Emerg Med. 2013;44(5):946–954.CrossRefGoogle ScholarPubMed
Stopyra, JP, Harper, WS, Higgins, TJ, et al. Prehospital modified HEART score predictive of 30-day adverse cardiac events. Prehosp Disaster Med. 2018;33(1):58–62.CrossRefGoogle ScholarPubMed
van Dongen, DN, Tolsma, RT, Fokkert, MJ, et al. Prehospital risk assessment in suspected non-ST-elevation acute coronary syndrome: a prospective observational study. Eur Heart J Acute Cardiovasc Care. 2020;9(suppl 1):5–12.CrossRefGoogle Scholar
van Dongen, DN, Fokkert, MJ, Tolsma, RT, et al. Value of prehospital troponin assessment in suspected non-ST-elevation acute coronary syndrome. Am J Cardiol. 2018;122(10):1610–1616.CrossRefGoogle ScholarPubMed
Alghamdi, A, Howard, L, Reynard, C, et al. Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid. Eur J Emerg Med. 2019;26(5):356–361.CrossRefGoogle ScholarPubMed
Body, R, Almashali, M, Morris, N, et al. Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay. Heart. 2019;105(10):768–774.CrossRefGoogle ScholarPubMed
Alghamdi, A, Cook, E, Carlton, E, et al. Prehospital evaluation of sensitive troponin (PRESTO) study: multicenter prospective diagnostic accuracy study protocol. BMJ Open. 2019;9(10):e032834.CrossRefGoogle ScholarPubMed
Supplementary material: File

Alghamdi et al. supplementary material

Alghamdi et al. supplementary material

Download Alghamdi et al. supplementary material(File)
File 20.7 KB