Impact of point-of-care testing in the emergency department evaluation and treatment of patients with suspected acute coronary syndromes.
OBJECTIVE
To assess the impact of point-of-care testing (POCT) for troponin I (cTnI) measurement on the time to anti-ischemic therapy (TAIT) for patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) presenting to the emergency department (ED).


METHODS
This was an open-label, randomized, single-center trial conducted in a university-affiliated hospital. cTnI measurement of patients with suspicion of NSTE-ACS coming to the ED was randomly allocated to POCT or central hospital laboratory testing (CHLT). The authors compared patients' baseline characteristics, time to anti-ischemic therapy, and medical outcomes between the randomized groups, in all study participants and in high-risk NSTE-ACS (cTnI level >or= 0.10 microg/mL), and in those with low suspicion ACS (no chest pain and no ST deviation).


RESULTS
Of the 860 patients enrolled, 113 were high-risk NSTE-ACS patients, including 53 (46.9%) allocated to POCT and 60 (53.1%) to CHLT. POCT was associated with decreased time to anti-ischemic therapy of about three-quarters of an hour, which was due to a shorter time to physician notification of cTnI level, in both all and subgroup participants. In contrast, neither ED length of stay nor medical outcomes differed between study groups.


CONCLUSIONS
Point-of-care testing for cTnI measurement might be clinically relevant for ED patients with a suspicion of NSTE-ACS, particularly for high-risk patients with a low suspicion of ACS.
Renaud
Bertrand
B
Structure des Urgences, AP-HP, Albert-Chenevier-Henri Mondor, Créteil, France. bertrand.renaud@hmn.aphp.fr
Maison
Patrick
P
Ngako
Alfred
A
Cunin
Patrick
P
Santin
Aline
A
Hervé
Jérôme
J
Salloum
Mirna
M
Calmettes
Marie-Jeanne
MJ
Boraud
Cyril
C
Lemiale
Virginie
V
Grégo
Jean Claude
JC
Debacker
Marie
M
Hémery
François
F
Roupie
Eric
E
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019095:Point-of-Care Systems; D019210:Troponin I / Q000097:blood
D019210:Troponin I