20 Oct New Point-of-Care Troponin Assay Can Rapidly Rule Out Heart Attack
MedicalResearch.com Interview with:
Dr John W Pickering, BSc(Hons), PhD, BA(Hons)
Associate Professor , Senior Research Fellow in Acute Care
Emergency Care Foundation, Canterbury Medical Research Foundation, Canterbury District Health Board | Christchurch Hospital
Research Associate Professor | Department of Medicine
University of Otago Christchurch
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The assessment of patients with suspected myocardial infarction is one of the most common tasks in the emergency department. Most patients assessed (80 to 98% depending on the health system) are ultimate not diagnosed with an MI. High-sensitivity troponin assays have been shown to have sufficient precision at low concentrations to allow very early rule-out of myocardial infarction. However, these are lab-based assays which typically result in a delay from blood sampling before the result is available and the physician is able to return to a patient to make a decision to release the patient or undertake further investigation. Point-of-care assays provide results much quicker, but have to-date not had the analytical characteristics that allow precise measurements at low concentrations.
In this pilot study we demonstrated that a single measurement with a new point-of-care assay (TnI-Nx; Abbott Point of Care) which can measure low troponin concentrations, could safely be used to rule-out myocardial infarction a large proportion of patients (57%). The performance was at least comparable to the high-sensitivity troponin I assay, if not a little better (44%).
MedicalResearch.com: What should readers take away from your report?
Response: We hope readers will be as excited as we are as this assay has the ability to make substantial gains for patients and hospitals alike. This new generation point-of-care troponin with its 15 minute turn-around-time to produce a result is likely to lead to very rapid rule-out of MI a substantial proportion of patients. This means patients will be reassured earlier that they are not having a heart attack, and emergency departments a little less crowded.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The first step is to expand our pilot study to cover many more patients so that we may with greater certainty establish a clinically relevant threshold for ruling-out MI. As with all troponin studies, it will be important to establish if it is safe for use in early presenters (those presenting within 2 or 3 hours of onset of symptoms). Following this, we would expect to see clinical studies within the ED incorporate TnI-Nx assay into the assessment pathway. Its utility would be demonstrated if the length of stay for those without an MI was reduced in the ED. Additional studies should look at use of the assay in rural locations where there is not ready access to a fully equiped laboratory and perhaps also in Ambulances where it may be used to decide on which hospital to take a patient.
MedicalResearch.com: Is there anything else you would like to add?
Response: The study was supported by a research grant from Abbott Point of Care. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; and decision to submit the manuscript for publication.
Pickering JW, Young JM, George PM, et al. Validity of a Novel Point-of-Care Troponin Assay for Single-Test Rule-Out of Acute Myocardial Infarction. JAMA Cardiol. Published online October 17, 2018. doi:10.1001/jamacardio.2018.3368
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