A novel point-of-care (POC) test can be used to diagnose or rule out myocardial infarction without the need for laboratory involvement and could improve the treatment of people presenting with chest pain in emergency departments (EDs), a trial has suggested.
The randomised controlled trial saw a new eight-minute blood test reduce the average length of stay for patients with chest pain when seen quickly by a doctor and those diagnosed with non-ST-elevation myocardial infarction (NSTEMI), compared to patients who received central laboratory testing.
The study involved 1,494 patients (median age 61 years, 43% female) presenting with symptoms suggestive of acute coronary syndrome (ACS) at Haukeland University Hospital in Norway between March 2022 and March 2024.
Researchers randomised the patients into two groups: one received standard investigations following the European Society of Cardiology 0/1h protocols for centralised high-sensitivity cardiac troponin (hs-cTn) T measurements (n=766) and the other received the intervention using a 0/1h POC hs-cTnI algorithm (n=728).
The average length of stay in the ED was 174 minutes for the POC testing group compared to 180 minutes in the standard testing group. However, among patients who were seen by a doctor within 60 minutes, POC testing reduced the length of stay in the emergency department by 15 minutes (147 vs 162 minutes).
The POC test provided the most benefit for patients with NSTEMI, which does not show ST-segment elevation on an ECG but requires urgent care. For these patients, the ED stay was shortened by an average of 43 minutes compared to the standard test (median 137 vs 180 minutes), and they were admitted to the cardiac ward faster.
POC testing did not compromise patient safety. Rates of combined deaths, myocardial infarction and acute revascularisations within 30 days were similar between the groups (11.4% POC vs 9.4% laboratory) and between discharge to 30-days follow-up (0.8% POC and 0.5% laboratory), indicating that both pathways have high and similar safety, with very few patients experiencing events after being discharged.
To realise the full potential of POC tests in the ED, inefficiencies that affect patient flow, such as lack of discharge staff or inefficient discharge procedures, must be addressed, the researchers concluded.
Reference
Thulin, I et al. Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain using Point of Care Testing (WESTCOR-POC): study design. Scandinavian Cardiovascular Journal 2023; Oct 31: DOI: 10.1080/14017431.2023.2272585.
