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Licensed Unlicensed Requires Authentication Published by De Gruyter December 19, 2017

Rule-out of non-ST elevation myocardial infarction by five point of care cardiac troponin assays according to the 0 h/3 h algorithm of the European Society of Cardiology

  • Durie Suh , Dagmar I. Keller , Danielle Hof , Arnold von Eckardstein EMAIL logo and Joanna Gawinecka EMAIL logo



Point of care (POC) assays for cardiac troponins I or T (cTnI or cTnT) may accelerate the diagnosis of patients with suspected acute coronary syndrome (ACS). However, their clinical utility according to the 0 h/3 h algorithm recommended by the European Society of Cardiology (ESC) for non-ST elevation myocardial infarction (NSTEMI) is unknown.


Blood samples from 90 patients with suspected ACS were obtained at hospital admission and 3 h later. Concentrations of cTn were determined using five POC assays (AQT90 FLEX cTnI and cTnT; PATHFAST™ cTnI; Stratus CS 200 cTnI; and Triage MeterPro cTnI) and two guideline-acceptable high-sensitivity (hs) immunoassays.


For the diagnosis of NSTEMI (n=15), AUCs for Abbott hs-cTnI and Roche hs-cTnT were 0.86 [95% confidence interval (CI), 0.75–0.96] and 0.88 (95% CI, 0.80–0.95), respectively, at admission, and 0.96 and 0.94, respectively, 3 h later. With the 99th percentile cutoff, their sensitivities were 62% and 92%, respectively, at admission, and 77% and 100%, respectively, 3 h later. The PATHFAST™ cTnI assay showed AUCs of 0.90 (95% CI, 0.82–0.97) and 0.94 (95% CI, 0.89–1.00), respectively, and sensitivities of 67% and 75% at admission and 3 h later, respectively. The other cTn POC assays had AUCs of 0.71 (95% CI, 0.53–0.89) to 0.84 (95% CI, 0.71–0.96) and 0.86 (95% CI, 0.72–0.99) to 0.87 (95% CI, 0.75–0.99) and sensitivities of 39%–50% and 62%–77% at admission and 3 h later, respectively.


PATHFAST™ cTnI assay proved itself as comparable to ESC-guideline acceptable hs-cTn assays. The lower sensitivity of the other POC assays limits their clinical utility and would require longer follow-up monitoring of patients for the safe NSTEMI rule-out.

Corresponding authors: Prof. Dr. Arnold von Eckardstein and Dr. Joanna Gawinecka, Institute for Clinical Chemistry, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091 Zurich, Switzerland, Phone: +41 44 255 2260, Fax: +41 44 255 4590

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Supplemental Material:

The online version of this article offers supplementary material (

Received: 2017-5-30
Accepted: 2017-11-8
Published Online: 2017-12-19
Published in Print: 2018-3-28

©2018 Walter de Gruyter GmbH, Berlin/Boston

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