Point-of-care testing for cardiac markers

Recent studies into point-of-care monitoring of a panel of cardiac markers, such as the RATPAC1 trial, have shown the value of point-of-care testing for rapidly ruling out acute coronary syndrome. This protocol has been adopted at Kettering General Hospital, where clinicians, laboratory staff and the ambulance service have worked together to establish a dedicated chest pain unit. The benefits of this streamlined treatment pathway for both patient and hospital are evident. Myocardial infarction can be rapidly ruled in or out, reducing unnecessary hospital admissions and enabling more efficient and cost-effective use of hospital resources.

The traditional care pathway for patients arriving at the emergency department suffering from chest pain is to perform a 12-hour troponin test to rule out acute coronary syndrome. However, as troponin takes some time to rise to a level that is detectable using conventional methods, a false negative result may be generated if measurements are taken too soon; the patient must be admitted purely to wait for a 12-hour troponin rule out to be performed.

This is frustrating for the patient, particularly in cases where the risk of acute coronary syndrome is low, and results in unnecessary occupation of an in-patient acute bed, which is a significant drain on the Trust’s resources. These patients could, potentially, be managed in a more efficient way by monitoring a panel of triple cardiac markers, with a larger proportion being discharged without the need for hospital admission.