[Real-life evaluation of hypersensitive I-troponin on a point-of care analyser in an emergency unit].

Abstract

European Society of Cardiology (ESC) guidelines allow to perform rapid rule-in and rule-out algorithm with rapid troponin kinetics for the management of suspected Non ST-elevation acute coronary syndrome. These recommendations allow the use of point-of-care testing (POCT) systems provided that they have sufficient analytical performance. The aim of our study was to evaluate in real life the feasibility and performance of using a high sensitivity cardiac troponin I POCT system assay (hs-cTnI, Atellica® VTLi, Siemens) compared to high sensitivity cardiac troponin T values (hs-cTnT, e602®, Roche) obtained for patients admitted to emergency department. Analytical verification showed a coefficient of variation below 10% for hs-cTnI. Comparison of both troponins was moderate (r = 0.7). The study included 117 patients with a median age of 65 years, 30% had renal failure and 36% presented with chest pain. In this study, the hs-cTnT value was, more often, higher than the 99th percentile than the hs-cTnl value, even for an age-adjusted 99th percentile hs-cTnT value. The concordance of the results was moderate (Cohen's Kappa: 0.54), age remaining the most important explanatory value of discordance. Only hs-cTnT had a predictive value for hospitalization. We did not observe any interpretation discrepancies for patients who had troponin kinetics. This study confirms the feasibility of using a POCT analyzer in the emergency department, provided that it performs high sensitivity troponin. However, some data are missing to be able to use it in the framework of rapid algorithm. Finally, the implementation of POCT requires collaboration between biologists and emergency physicians in terms of organization and interpretation of values, for the overall benefit of the patient.