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Effectiveness of Point-of-Care High-Sensitivity Troponin Testing in the Emergency Department: A Randomized Controlled
Viola I L Thulin1, Silje M F Jordalen1, Gard M S Myrmel2
1Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.
Insights
Point-of-care high-sensitivity cardiac troponin (hs-cTn) testing in the emergency department did not significantly reduce patient length of stay. This diagnostic approach also showed no difference in major adverse cardiac events within 30 days.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Diagnostics
Background:
- Acute coronary syndrome (ACS) requires rapid diagnosis in the emergency department (ED).
- High-sensitivity cardiac troponin (hs-cTn) assays are crucial for ACS evaluation.
- Point-of-care testing (POCT) offers potential for faster results compared to central laboratory analysis.
Purpose of the Study:
- To compare the effectiveness of hs-cTn point-of-care testing (POCT) versus central laboratory measurements for ACS investigation in the ED.
- To evaluate the impact of POCT on emergency department length of stay (LOS).
Main Methods:
- A single-center prospective randomized controlled trial (WESTCOR study) was conducted.
- Patients with possible ACS were randomized 1:1 to receive either 0/1-hour centralized hs-cTnT or 0/1-hour point-of-care hs-cTnI testing.
- The primary endpoint was ED length of stay, with a minimum clinically meaningful difference set at 15 minutes.
Main Results:
- 1,494 patients were analyzed; 728 in the POCT group and 766 in the control group.
- Median ED LOS was 174 minutes for POCT versus 180 minutes for the control group, a non-significant reduction of 6 minutes.
- Rates of acute myocardial infarction, death, or acute revascularization within 30 days were similar between groups (11.4% vs. 9.4%).
Conclusions:
- Implementing point-of-care hs-cTnI testing with a 0/1-hour algorithm did not achieve a clinically meaningful reduction in ED LOS.
- No significant difference in major adverse cardiac events was observed between POCT and central laboratory testing during 30-day follow-up.
Study Objective:
To compare the effectiveness of high-sensitivity cardiac troponin (hs-cTn) point-of-care testing to central laboratory hs-cTn measurements when investigating patients presenting to the emergency department (ED) with symptoms of acute coronary syndrome.
Methods:
The WESTCOR point-of-care study was a single-center prospective randomized controlled trial where we randomized patients presenting with possible acute coronary syndrome in a 1:1 fashion to receive either 0/1-hour centralized hs-cTnT measurements (control) or 0/1-hour point-of-care hs-cTnI testing (intervention). We defined length of stay (LOS) in the ED as the primary endpoint and the minimum clinically meaningful difference as 15 minutes.
Results:
We included 1,494 patients in the final analysis, 728 in the point-of-care group, and 766 in the control group. The median (interquartile range) age was 61 (22) years, and 635 (42.5%) were women. Median LOS in the ED was 174 (95% confidence interval [CI] 167 to 181) and 180 (95% CI 175 to 189) minutes in the point-of-care and control group, respectively, resulting in a reduction in median LOS of 6 minutes (95% CI -4 to 17). Acute myocardial infarction, death, or acute revascularization occurred in 83/728 (11.4%) of point-of-care and 72/766 (9.4%) of control patients.
Conclusions:
We found that implementing point-of-care hs-cTnI testing in the ED with a 0/1-hour diagnostic algorithm did not lead to a clinically meaningful reduction in ED LOS. We observed no difference in the incidence of myocardial infarction, acute coronary revascularization, or death during 30 days follow-up.
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