Point-of-care tests in suspected acute myocardial infarction: a systematic review

A review of cardiac point-of-care (POC) tests used to detect or exclude acute myocardial infarction (AMI) with a focus on test performance within 6 hours after the start of symptoms.

A systematic review of articles on the diagnostic accuracy of point of care (POC) tests in patients suspected of AMI from the PubMed database from January 1st 1990 to December 1st 2012.

Our search yielded 42 studies evaluating POC tests. Troponin (Tn) was investigated in 29 studies, and creatine kinase-myocardial band isoenzyme (CK-MB), myoglobin, and heart-type fatty acid-binding protein (H-FABP) each in 13 studies. Eight studies used a multimarker approach. In 14 studies results were presented or could be recalculated for test results within 6 hours of symptom onset or with a median time from symptoms onset to testing of 3 hours. In this time frame the negative predictive value (NPV) ranged from 31 to 97% with single testing, and from 59 to 100% with a multi-marker approach. Just one study satisfied to all items used for methods appraisal.

The ideal POC test for the diagnosis of AMI within 6 hours after the onset of symptoms does not yet exist. Evaluated POC tests were in general of poor methodological quality and reported too many false negatives to be considered as save for the assessment of patients suspected of AMI. A POC test of high-sensitive troponin could possibly fill the gap in the early hours after symptom onset, especially in those with non-definitive electrocardiography.