J Lab Med Qual Assur.  2017 Jun;39(2):83-89. 10.15263/jlmqa.2017.39.2.83.

Clinical Usefulness of Combined Cardiac Marker Testing with a Point-of-Care Device at the Emergency Department

Affiliations
  • 1Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea.
  • 2Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea. ymyun@kuh.ac.kr
  • 3Green Cross Laboratories, Yongin, Korea.

Abstract

BACKGROUND
B-type natriuretic peptide (BNP) levels are elevated in various conditions unrelated to heart failure, such as acute coronary syndrome, and cardiac troponin (cTn) levels may also be elevated in several non-ischemic conditions. This study aimed to evaluate the clinical usefulness of combined cardiac marker testing (BNP and cTnI) with point-of-care devices in patients who presented to the emergency department (ED).
METHODS
Two thousand six hundred and seventy-four consecutive patients who visited the ED from March to August 2013 were included in this study. Cardiac marker testing was performed using the Triage Cardio3 panel (Alere, USA). Electronic medical records were collected on August 2014.
RESULTS
We found that 22.2% patients had elevated BNP and/or cTnI (12.8% with only elevated BNP, 4.4% with only elevated cTnI, and 5.0% with both elevations). Patients with elevations in both marker levels showed significantly higher admission rate (78.5% vs. 62.7%, P=0.006) and longer length of hospital stay (11 vs. 6 days, P=0.001) than those with only elevated cTnI. Patients with elevations in both marker levels also showed higher admission rate (78.5% vs. 67.3%, P=0.016) and higher BNP levels (430 vs. 194 pg/mL, P<0.001) than those with only elevated BNP.
CONCLUSIONS
Concurrent elevation of BNP and cTnI may be associated with inferior clinical outcome and combined testing of cTnI and BNP levels with high sensitivity would provide important information for assisting management decisions at the ED.

Keyword

Troponin I; B-type natriuretic peptide; Emergency department
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