The American Cardiovascular Society recommends measuring cardiac troponin (cTn) I or T levels in patients presenting with symptoms of acute coronary syndrome (ACS). cTn levels increase with damage to the heart from an insufficient blood supply, and measuring these levels is a sensitive test for the detection of heart muscle damage. However, cTn levels may also be elevated in other conditions, and therefore clinical assessment and electrocardiogram (ECG) findings are also required to diagnose myocardial infarction (MI). ACS includes ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. Because NSTEMI does not exhibit changes typical of an MI on ECG, measurement of cTn is important for diagnosis.

Troponin is typically measured by central laboratory testing; however, central laboratories are not always available, particularly in rural or remote settings. Point-of-care (POC) cTn testing therefore has the potential to improve patient care in these settings, reducing unnecessary and often expensive transfers to hospitals, and allowing patients to receive care in their community.

To assist decision-makers considering the implementation of POC troponin testing, CADTH conducted a health technology assessment (HTA) on the clinical utility, diagnostic accuracy, and cost-effectiveness of POC troponin testing in different settings. Settings with access to a central laboratory (such as an emergency department [ED]), and settings with no immediate access to a central laboratory (such as rural hospitals or health care centres, remote settings, or remote nursing stations) were considered.

Contents

• Abbreviations
• 1. Summary of Recommendations
  • 1.1 Technology
• 2. Methods
• 3. Detailed Recommendations
  • 3.1 Rationale
  • 3.2 Considerations
• 4. Background
  • 4.1 Research Questions
  • 4.2 Summary of the Clinical Evidence
  • 4.3 Summary of the Economic Evidence
• References
• Appendix 1 Health Technology Expert Review Panel

About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.

Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. Views: The views expressed herein are those of CADTH and do not necessarily reflect the views of our funders.

Suggested citation:

Point-of-Care Troponin Testing in Patients With Symptoms Suggestive of Acute Coronary Syndrome: Recommendations. Ottawa: CADTH; 2016 Mar. (CADTH optimal use report; vol.5, no.1c).

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time it was prepared, and it was guided by expert input and advice throughout its preparation.

The information in this report is intended to help health care decision-makers, patients, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this report to ensure that its contents are accurate, complete, and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report.

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.

Production of this report is made possible through a financial contribution from Health Canada.