Cardiac markers: point of care testing

Point-of-care (POC) or "near-patient" testing allows diagnostic assays to b e performed in locations such as the emergency department or intensive care unit where treatment decisions are made and care is delivered based on the results of these assays. Presently, there exist POC immunoassays for sever al cardiac markers including creatine kinase MB (CK-MB), myoglobin, troponi n I, and troponin T that yield qualitative and quantitative results compara ble to traditional central lab assays. In the evaluation of emergency room patients with chest pain, POC cardiac markers may improve triage and clinic al outcomes. Existing POC assays combining myoglobin and CK-MB have high se nsitivity and specificity for diagnosing acute myocardial infarction and ma y provide the earliest identification of myocardial injury. POC Troponin T assays are the most studied POC cardiac marker assays. Along with POC tropo nin I assays, these tests provide more sensitive identification of myocardi al injury and valuable prognostic information. Prior studies of POC cardiac marker assays have not addressed whether POC testing affects patient outco me or process of care. In situations in which caregivers base triage, treat ment and monitoring decisions on time-sensitive diagnostic results, POC tes ts linked with improved triage and treatment strategies may improve resourc e utilization and clinical outcomes. (C) 1999 Elsevier Science B.V. All rig hts reserved.