NEW YORK (Reuters Health) – Use of a point-of-care troponin T assay by paramedics before patients with suspected acute MI reach the hospital is feasible and has a high success rate in identifying actual MI cases, a Danish team reports.

Dr. Jacob Thorsted Sorensen, at Aarhus University Hospital, and colleague explain in the American Journal of Cardiology online March 18 that prehospital ECGs are often equivocal in diagnosing acute MI. “We aimed to investigate the feasibility and ability of prehospital troponin T testing to improve diagnosis in patients with chest pain transported by ambulance.”

The group’s study encompassed patients with suspected MI in the central Denmark region. When an appropriately trained paramedic was present on the ambulance, the patients were tested for troponin T using a qualitative assay with a cutpoint of 0.10 ng/mL.

Over a 15 month period, prehospital troponin testing was accomplished in 97% of 958 patients. The test was positive in 69 of these patients, which was subsequently confirmed in 65 by in-hospital measurements using a more sensitive quantitative assay.

Among patients having a prehospital test, 78 were triaged directly to the cath lab for primary PCI, and in 9 of these cases the decision was based primarily on the positive troponin T result because the ECG was equivocal.

Ultimately, a diagnosis of acute MI was established in 208 patients; prehospital testing identified 30% of them, compared with 79% detected by the first in-hospital test.

“Because a considerable proportion of patients with AMI have increased troponin T on hospital arrival, it is likely that most patients with AMI could be diagnosed before hospital arrival if more sensitive point-of-care tests are introduced in the prehospital phase,” Dr. Sorensen and colleagues suggest. They note that point-of-care kits with lower detection limits are currently available.

Reference:
Second-Trimester Abortion for Fetal Anomalies or Fetal Death: Labor Induction Compared With Dilation and Evacuation
SOURCE: http://dx.doi.org/10.1016/j.amjcard.2011.01.014
Am J Cardiol 2001.