title: Three-month outcome of patients with suspected acute coronary syndrome using point-of-care cardiac troponin-T testing compared with laboratory-based cardiac troponin-T testing: a randomised trial.
abstract: OBJECTIVE
  The aim of this randomised trial was to determine clinical outcomes in patients suspected of an acute coronary syndrome (ACS) who had cardiac troponin-T measured by point-of-care (POC) compared with laboratory-based cardiac troponin-T testing. A secondary aim was to describe the correlation between the two troponin assays.
  
  
  METHODS
  Adults suspected of ACS were allocated to have troponin processed by POC or laboratory analyser. The primary outcome was a composite of acute myocardial infarction, coronary revascularisation, cardiac arrest and mortality at 3 months. Paired troponins taken on participants allocated to POC were used to determine correlation between troponin values obtained from laboratory and POC analysers.
  
  
  RESULTS
  There were 452 participants. 30 (13.1%) of 229 participants allocated to POC had at least one primary outcome event compared with 29 (13.0%) of 223 allocated to laboratory testing, a difference of 0.1% (95% CI -6.2% to 6.4%, p=0.98). Of 215 available paired troponins results, both analysers gave congruent results in 196 (91%) cases. The POC troponin was negative when the laboratory sample was positive in 16 (7%) cases. The POC troponin was positive when the laboratory sample was negative in 3 (1%) samples. Passing-Bablok regression analysis demonstrated both a constant and proportional difference between the two analytic methods.
  
  
  CONCLUSIONS
  Among patients suspected of an ACS, we found no evidence for a difference in adverse outcome when POC troponin was used in comparison with laboratory troponin. Due to the small sample size, an absolute difference of up to 6% in adverse outcome is possible.
  
  
  BACKGROUND
  ANZCTR#12612000319875.
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Stephen Edward
authors.initials: SE
authors.lastname: Asha
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cooke
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Walter
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Cardiology Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Weaver
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: cardiac care, acute coronary syndrome; cardiac care, diagnosis