Mottin, Léo <br/><br/>
Real-life evaluation of a hypersensitive troponin I measurement on a point-of-care analyzer in an emergency unit 

 -  2023.<br/>							 
<br/><br/> 19 
<br/><br/> European Society of Cardiology (ESC) guidelines introduce the possibility of a rule-in and rule-out algorithm with rapid troponin kinetics to be created in order to manage suspected Non ST-elevation acute coronary syndrome. These recommendations allow the use of point-of-care testing (POCT) systems provided that they have sufficient analytical performance. The aim of our study was to evaluate in real life the feasibility and performance of using a high-sensitivity cardiac troponin I POCT system assay (hs-cTnI, Atellica® VTLi, Siemens) compared to values obtained by a high-sensitivity cardiac troponin T test (hs-cTnT, e602®, Roche) for patients admitted to the emergency department. Analytical verification showed a coefficient of variation below 10% for hs-cTnI. Comparison of both troponins was moderate (r = 0.7). The study included 117 patients with a median age of 65 years, 30% of whom had kidney failure and 36% of whom presented with chest pain. In this study, the hs-cTnT value was more often above the 99th percentile than the hs-cTnl value, even for an age-adjusted 99th percentile hs-cTnT value. The concordance of the results was moderate (Cohen’s Kappa: 0.54), with age remaining the most important explanatory value of discordance. Only hs-cTnT had a predictive value for hospitalization. We did not observe any interpretation discrepancies for patients who had troponin kinetics. This study confirms the feasibility of using a POCT analyzer in the emergency department, provided that it performs a high-sensitivity troponin test. However, some data are missing to be able to use it as part of a rapid algorithm. Finally, the implementation of POCT requires collaboration between biologists and emergency physicians in terms of organization and interpretation of values, for the overall benefit of the patient.