Ter Avest Ewoud, Visser Anniek, Reitsma Bram, Breedveld Rob, Wolthuis Albert
Departments of aEmergency Medicine bCardiology cClinical Chemistry, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
Eur J Emerg Med. 2016 Apr;23(2):95-101. doi: 10.1097/MEJ.0000000000000225.
Point-of-care testing (POCT) cardiac troponin (cTn) measurements are being used increasingly, despite the fact that evidence on the safety of their use is outdated, not taking into account current 'gold standard' high-sensitivity cardiac troponin (hs-cTn) assays. In the present study, we aimed to compare the analytical and diagnostic performance of the AQT90-flex POCT cTnT assay (which is the POCT assay with the lowest reported 99th percentile cutoff currently available) with the laboratory-based Roche Modular E170 hs-cTnT assay.
During a 4-month prospective observational cohort study, laboratory-based hs-cTnT and POCT cTn were measured simultaneously in 261 undifferentiated chest-pain patients presenting to the emergency department (ED) of the Medical Centre Leeuwarden to determine the diagnostic accuracy of both assays in predicting acute myocardial infarction (AMI) at presentation.
The POCT cTn assay had a lower sensitivity [68 (49-82) vs. 91 (75-98)] and a lower negative predictive value [95 (91-97) vs. 98 (95-100)%] for the prediction of AMI at presentation compared with the hs-cTnT assay. Furthermore, in three patients, the POCT cTnT assay yielded unexpectedly high results, whereas hs-cTnT results were negative. None of these patients had an AMI, and no possible explanation could be found.
The AQT90-flex POCT cTnT assay is not yet sensitive and reliable enough to be used to exclude AMI in the ED with a single blood draw at the time of presentation in the ED, and therefore, may have limited applicability in the ED setting.
即时检验（POCT）心肌肌钙蛋白（cTn）检测的使用日益增加，尽管关于其使用安全性的证据已过时，且未考虑当前的“金标准”高敏心肌肌钙蛋白（hs-cTn）检测方法。在本研究中，我们旨在比较AQT90-flex POCT cTnT检测方法（这是目前报道的第99百分位数临界值最低的POCT检测方法）与基于实验室的罗氏Modular E170 hs-cTnT检测方法的分析性能和诊断性能。
在一项为期4个月的前瞻性观察队列研究中，对261名前往吕伐登医疗中心急诊科就诊的未分化胸痛患者同时进行基于实验室的hs-cTnT检测和POCT cTn检测，以确定两种检测方法在预测就诊时急性心肌梗死（AMI）方面的诊断准确性。
与hs-cTnT检测方法相比，POCT cTn检测方法在预测就诊时的AMI方面敏感性较低[68（49 - 82）对91（75 - 98）]，阴性预测值也较低[95（91 - 97）对98（95 - 100）%]。此外，有3名患者的POCT cTnT检测结果意外地高，而hs-cTnT结果为阴性。这些患者均未发生AMI，且未找到可能的解释。
AQT90-flex POCT cTnT检测方法在急诊科就诊时单次抽血用于排除AMI的敏感性和可靠性还不够，因此在急诊科环境中的适用性可能有限。
