Abstract

Cardiac Point of Care – Current Technology and Future Directions

Paul Collinson, Consultant Chemical Pathologist, St Georges University Hospitals NHS Foundation Trust

The largest category of medical presentations to the Emergency Department is patients with chest pain and suspected acute coronary syndrome (ACS). Cardiac troponin has emerged over the past 20 years as the gold standard biochemical test for assessment of this patient group. Point of care testing (POCT) for cardiac troponin was an early innovation and was perceived as valuable both by the ED physician and the cardiologist. Two types of approach we used, one initially semi-quantitative and the other using compact laboratory style equipment. Subsequent refinement of laboratory-based troponin methods has been combined with development of rapid diagnostic protocols for early patient disposition. The development of high sensitivity troponin assays plus an emphasis on very early (within 2 hours) exclusion of acute myocardial infarction produces a creative tension. On one hand, very rapid turnaround time is required which can only be met by POCT and on the other hand, current POCT technology is inadequately sensitive. The future challenge is therefore to develop laboratory quality POCT assays but in a format suitable for use in the POCT environment and to combine this with connectivity to integrate the result with the patient record.