Point-of-Care Testing for Cardiac Markers

  • Robert H. Christenson
Part of the Pathology and Laboratory Medicine book series (PLM)


Clinical pathology responsibility has evolved into a spectrum of testing ranging from: direct patient and POC monitoring → near patient testing in a satellite laboratory → specimen transport and measurement in an in-house centralized laboratory → referral of esoteric testing to outside institutions. The “wavelength” of a specific analyte in this spectrum is driven by a balance between the urgency with which the results are needed for patient care utilization, the availability of appropriate technology, and cost. However, unlike nature where the spectral wavelength is a static characteristic, the performance site of various analytes can evolve with acquisition of knowledge and technology development.


Acute Myocardial Infarction Acute Myocardial Infarction Thrombolytic Therapy Cardiac Troponin Myocardial Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Jaffe AS (1993) More rapid biochemical diagnosis of myocardial infarction: Necessary? Prudent? Cost effective? [Editorial] Clin. Chem. 39:1567–1569.PubMedGoogle Scholar
  2. 2.
    Newby LK, Gibier WB, Ohman EM, and Christenson RH (1995) Biochemical markers in suspected acute myocardial infarction: the need for early assessment [Editorial]. Clin. Chem. 41:1263–1265.PubMedGoogle Scholar
  3. 3.
    Young G, Hedges JR, Gibier WB, Green TR, and Swanson RJ (1990) Do CK-MB results affect chest pain decision making in the Emergency department? Ann. Emerg. Med. 19:1218–1219.Google Scholar
  4. 4.
    Emergency department: Rapid identification and treatment of patients with acute myocardial infarction. Ann. Emerg. Med. 23: 311–329, 1994.CrossRefGoogle Scholar
  5. 5.
    Bahr RD (1995) The changing paradigm of acute heart attack prevention in the emergency department: A futuristic viewpoint. [Editorial] Ann. Emerg. Med. 25:95–96.PubMedGoogle Scholar
  6. 6.
    Sayre MR and Gibier WB (1996) New approaches to ruling out acute ischemic coronary syndrome in the emergency department. Ann. Emerg. Med. 27:1–7.CrossRefGoogle Scholar
  7. 7.
    Gruppo Italiano per lo Studio dell nell’Infarto Miocardico (GISSI) (1986) Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1:397–402.Google Scholar
  8. 8.
    The GUSTO angiographic investigators (1993) The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. N. Engl. J. Med. 329:1615–1622.CrossRefGoogle Scholar
  9. 9.
    Fesmire FM, Wharton DR, and Calhoun FB (1995) Instability of ST segments in the early stages of acute myocardial infarction in patients undergoing continuous 12-lead ECG monitoring. Am. J. Emerg. Med. 13:158–163.PubMedCrossRefGoogle Scholar
  10. 10.
    Rusnak RA, Stair TO, Hansen K, and Fastow JS (1989) Litigation against the emergency physician: Common features in cases of missed myocardial infarction. Ann. Emerg. Med. 18:1029–1034.PubMedCrossRefGoogle Scholar
  11. 11.
    Tucker JF, Collins RA, Anderson AJ, Hess M, Farley I, Hagemann DA, Harkins HJ, and Zwicke D (1994) Value of serial myoglobin levels in early diagnosis of patients admitted for acute myocardial infarction. Ann. Emer. Med. 24:704–708.CrossRefGoogle Scholar
  12. 12.
    Brogan GX, Friedman S, McCuskey C, Cooling DS, Burrutti L, Thode HC, and Bock JL (1994) Evaluation of a rapid immunoassay for serum myoglobin versus CK-MB for ruling out acute myocardial infarction in emergency department. Ann. Emer. Med. 24:665–671.CrossRefGoogle Scholar
  13. 13.
    Hedges JR, Rouan GW, Toltis R, Goldstein-Wayne B, and Stein EA (1987) Use of cardiac enzymes identifies patients with acute myocardial infarction otherwise unrecognized in the emergency department. Ann. Emer. Med. 16:248–252.CrossRefGoogle Scholar
  14. 14.
    Gibier WB, Runyon JP, Levy RC, Sayre MR, Kacich R, Hattemer CR, Hamilton C, Ger-lach JW, and Walsh RA (1995) A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann. Emerg. Med. 25:1–8.CrossRefGoogle Scholar
  15. 15.
    Levitt MA, Promes SB, Bullock S, Disano M, Young GP, Gee G, and Pearslee D (1996) Combined cardiac marker approach with adjunct two-dimensional echocardiography to diagnose acute myocardial infarction in the emergency department. Ann. Emerg. Med. 27:1–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Antman EM, Grudzien C, and Sacks DB (1995) Evaluation of a rapid bedside assay for detection of serum cardiac troponin T. JAMA 273:1279–1282.PubMedCrossRefGoogle Scholar
  17. 17.
    Wu AHB and Lane PL (1995) Metaanalysis in Clinical Chemistry: validation of cardiac troponin T as a marker for ischemic heart diseases. Clin. Chem. 41:1228–1233.PubMedGoogle Scholar
  18. 18.
    Alonsozana GL and Christenson RH (1996) The case for cardiac troponin T: A marker for effective risk stratification of patients with acute cardiac ischemia. Clin. Chem. 42: 803–808.PubMedGoogle Scholar
  19. 19.
    Lindahl B, Venge P, and Wallentin L (1996) Relation between troponin T and the risk of cardiac events in unstable angina. Circulation 96:1651–1657.CrossRefGoogle Scholar
  20. 20.
    Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus H, Hamm CW, O’Hanesian MA, Lee KL, Wagner GS, Kleiman NS, Harrell FE Jr, Califf RM, and Topol EJ, for the GUSTO-IIa Investigators (1996) Risk stratification with admission cardiac troponin T levels in acute myocardial ischemic. N. Engl. J. Med. 335:1333–1341.PubMedCrossRefGoogle Scholar
  21. 21.
    Wu AHB, Feng YJ, and Contois JH (1996) Prognostic value of cardiac troponin I in patients with chest pain [Letter]. Clin. Chem. 42:651–652.PubMedGoogle Scholar
  22. 22.
    Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, Fischer GA, Fung AY, Thompson C, Wybenga D, and Braunwald E (1996) Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N. Engl. J. Med. 335:1342–1349.PubMedCrossRefGoogle Scholar
  23. 23.
    Wu AHB, Abbas SA, Green S, Pearsall P, Dhakam S, Azar R, Onoroski M, Senaie A, McKay R, and Waters D (1995) The prognostic value of cardiac troponin T in patients with unstable angina. Am. J. Cardiol. 76: 970–972.PubMedCrossRefGoogle Scholar
  24. 24.
    Stubbs P, Collinson P, Moseley D, Greenwood T, and Noble M (1996) Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. Circulation 94:1291–1297.PubMedCrossRefGoogle Scholar
  25. 25.
    Muller-Bardorff M, Freitag H, Scheffold T, Remppis A, Kubier W, and Hatus HA(1995) Development and characterization of a rapid assay for bedside determinations of cardiac troponin T. Circulation 92:2869–2875.PubMedCrossRefGoogle Scholar
  26. 26.
    Christenson RH, Fitzgerald RL, Ochs L, Rozenberg M, Frankel WL, Herold DA, Duh SH, Alonsozana GL, and Jacobs E (1997) Characteristics of a 20-minute whole blood rapid assay for cardiac troponin T. Clin. Biochem. 30:27–33.PubMedCrossRefGoogle Scholar
  27. 27.
    Anderson JL, Karagounis LA, Becker LC, Sorensen SG, and Menlove RL (1993) TIMI perfusion grade 3 but not grade II results in improved outcome after thrombolytic therapy. Circulation 87;1542–1550.CrossRefGoogle Scholar
  28. 28.
    Ohman EM, Christenson RH, Califf RM, George BS, Samaha JK, Kereiakes DJ, Worley SJ, Wall TC, Berrios R, Sigmon KN, Lee KL, and Topol EJ (1993) Noninvasive detection of reperfusion after thrombolysis based on serum creatine kinase MB changes and clinical variables. Am. Heart J. 126: 819–826.PubMedCrossRefGoogle Scholar
  29. 29.
    Christenson RH, Ohman EM, Topol EJ, O’Hanesian MA, Sigmon KN, Duh SH, Kereiakes D, Worley SJ, George BS, Alonsozana Wall TC, and Califf RM (1997) Combining myoglobin, creatine kinase-MB and clinical variables for assessing coronary reperfusion after thrombolytic therapy. Circulation 96:1776–1782.PubMedCrossRefGoogle Scholar
  30. 30.
    Buda AJ, MacDonald IL, Dubbin JD, Orr SA, and Strauss HD (1983) Myocardial infarct extension: prevalence, clinical significance, and problems in diagnosis. Am. Heart J. 105:744–749.PubMedCrossRefGoogle Scholar
  31. 31.
    Weisman HF and Healy B (1987) Myocardial infarct expansion, infarct extension, reinfarction and pathophysiological concepts. Prog. Cardiovasc. Dis. 30:73–110.PubMedCrossRefGoogle Scholar
  32. 32.
    Ehrmeyer SS and Laessig RH (1995) Regulatory requirements (CLIA ‘88, JCAHO, CAP) for decentralized testing. Am. J. Clin. Pathol. 104(suppl 1): S40–S49.PubMedGoogle Scholar
  33. 33.
    Lee TH, Rouan GW, Weisberg MC, Brand DA, Cook EF, Acampora D, and Goldman L (1987) Sensitivity of routine clinical criteria for diagnosing myocardial infarction within 24 hours of hospitalization. Ann. Intern. Med. 106:181–186.PubMedGoogle Scholar
  34. 34.
    Lott JA and Stang JM (1989) Differential diagnosis of patients with abnormal serum creatine kinase isoenzymes. Clin. Lab. Med. 9:627–642.PubMedGoogle Scholar
  35. 35.
    de Winter RJ, Koster RW, Sturk A, and Sanders GT (1995) Value of myoglobin, troponin T and CK-MBmass in ruling out an acute myocardial infarction in the emergency room. Circulation 92:3401–3407.PubMedCrossRefGoogle Scholar
  36. 36.
    Piran U, Kohn DW, Uretsky LS, Bernier D, Barlow EK, Kiswander CZ, and Stastny M (1987) Immunochemiluminometric assay of creatine kinase MB with a monoclonal antibody to the MB isoenzyme. Clin. Chem. 33:1517–1520.PubMedGoogle Scholar
  37. 37.
    Collinson PO, Thomas S, Siu L, Vasudeva P, Stubbs PJ, and Canepa-Anson R (1995) Rapid troponin T measurement in whole blood for detection of myocardial damage. Ann. Clin. Biochem. 32:454–458.PubMedGoogle Scholar
  38. 38.
    Katus HA, Looser S, Hallermayer K, Remppis A, Scheffold T, Borgya A, Essig U, and Geub U (1992) Development and in vitro characterization of a new immunoassay of cardiac troponin T. Clin. Chem. 38:386–393.PubMedGoogle Scholar
  39. 39.
    Mach F, Lovis C, Chevrolet JC, Urban P, Unger PF, Bouillie M, and Gaspoz JM (1995) Rapid bedside whole blood car-diospecific troponin T immunoassay for the diagnosis of acute myocardial infarction. Am. J. Cardiol. 75:842–845.PubMedCrossRefGoogle Scholar
  40. 40.
    Goldmawn BU, Hamm CW, Schneider JC, Geschen M, and Melnertz T (1997) The value of bedside troponin T testing in the emergency room for risk stratification in patients with chest pain after discharge from hospital. J. Am. Coll. Cardiol. 27(Suppl):359A.CrossRefGoogle Scholar
  41. 41.
    Brogan GX, Bock J, Hollander J, McCuskey C, Khan S, Thode H, Broderick J, Henry M, Dinowitz S, Katz K, and Valentine S (1996) Evaluation of cardiac STATus creatine kinase-MB/myoglobin device for rapidly ruling out acute myocardial infarction [Abstract]. Acad. Emerg. Med. 3:106.CrossRefGoogle Scholar
  42. 42.
    Murthi P, Young GP, Levitt A, and Gawad Y (1996) Serial use of rapid qualitative multi-marker bedside immunoassays for the detection of cardiac ischemia in ED patients with chest pain and possible acute myocardial infarction [Abstract]. Acad. Emerg. Med. 3:107.Google Scholar

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© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Robert H. Christenson

There are no affiliations available

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