Cardiac biomarkers are now established in guidelines for the diagnosis of acute coronary syndromes. As analytical technologies develop to give methods capable of lower limits of detection and faster delivery of results, the applications of these markers have also evolved, especially in the case of markers of myocardial ischemia. From a pathophysiological perspective, the goal for these markers is a test that will provide early evidence of ischemic damage, thrombus evolution, and cardiac dysfunction. From an outcomes perspective, the key goals require a test that can assist in the early diagnosis of patients presenting with symptoms suggestive of an acute coronary syndrome to facilitate reliable risk stratification, and efficient triage to an early intervention.
Point-of-care testing can help to meet these objectives. There is evidence that the use of multiple marker tests using measurements myoglobin, creatine kinase MB, and troponin I is effective in the rapid rule out of myocardial infarction in patients presenting to the emergency department. The more sensitive troponin I methods can also meet this same objective, as well as possibly having a role in the use of telecardiology diagnosis in the paramedical vehicle. Early work on fatty acid binding protein measurement also suggests it may be a useful early marker.
Point-of-care testing can reduce (i) the time to intervention, (ii) the number of patients admitted to a coronary care unit, (iii) the length of stay in the emergency department, and (iv) the total cost of the care episode.
From the Department of Clinical Biochemistry, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
Reprints: Christopher P. Price, PhD, Department of Clinical Biochemistry, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom (e-mail: firstname.lastname@example.org).