Point-of-Care Cardiac Troponin Testing as a Timely and Cost Effective Measure in Diagnosis of Acute Myocardial Infarction

In patients with chest pain of suspected cardiac etiology or possible acute coronary syndrome (ACS), cardiac biomarkers are used to aid in diagnosis, treatment, and risk stratification. Cardiac troponin (cTn) point-of-care testing (POCT) exists to assist clinicians and facilities to rapidly make decisions, increase accuracy of diagnosis, increase emergency department (ED) throughput, and decrease ED length-of-stay (LOS). Although many ST Elevation Myocardial Infarction (STEMI) diagnoses are made based off of an initial electrocardiogram (ECG) and patient presentation, cardiac biomarkers also provide further insight to STEMI diagnosis and help clarify varying patient presentations. The purpose of this paper is to evaluate cTn POCT as an evidence-based practice (EBP). A critical appraisal of the literature was performed using 12 articles selected for final synthesis. The final articles were then formally synthesized and discussed in relation to EBP. Results of the EBP evaluation showed that cTn POCT accurately assists in diagnosis when compared to traditional laboratory cTn testing, facilitates risk stratification, increases ED throughput, decreases ED LOS, and aids in meeting the recommended time-to-troponin of 30-60 minutes. However, data regarding general cost effectiveness with cTn POCT was limited and varied with result.