Cardiac markers of acute coronary syndromes: is there a case for point-of-care testing?

Objective: Major challenges for physicians include selection of effective tests in the time-sensitive identification and management of patients with acute coronary syndromes (ACS). We review whether cardiac marker testing performed at the point-of-care (POC) has an impact on clinical management and guidance of intervention for ACS patients. Design and Methods: Evidence from recently published studies and meta-analyses supports the efficacy of cardiac markers. Technologies and specifications of all currently available POC tests for monitoring cardiac markers are surveyed. Finally. a series of questions to investigate the utility of cardiac markers, and their measurement by POC tests, for clinical management and guidance of therapy for ACS patients, are addressed. Results: Cardiac troponins are clearly the best markers for the definitive detection of myocardial infarction. Compelling evidence for the utility of troponins in risk stratification and guidance of intervention for ACS patients has resulted in inclusion of cardiac markers in clinical guidelines. Rapid multi-analyte POC tests, few of which exhibit harmony with central laboratory assays, have facilitated the use of cardiac markers for clinical management and guidance of therapy. Conclusions: Given the need to minimize vein-to-brain time, it is expected that point-of-care testing of cardiac markers will take a leading role in management of ACS patients. (C) 2002 The Canadian Society of Clinical Chemists. All rights reserved.