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pre-hospital
patient care
innovation
evidence
clinical skills

Prehospital point-of-care biomarkers: missing link in acute myocardial infarction?

02 March 2022
Features
02 March 2022
Volume 14 · Issue 3

Abstract

Coronary heart disease is a leading cause of death worldwide. Paramedics are instrumental in the treatment, triage and transport of patients experiencing acute coronary syndromes and acute myocardial infarction (AMI). Paramedics currently rely on prehospital electrocardiography and patient symptomology to diagnose AMI, which may result in missed diagnoses. Point-of-care biomarkers such as cardiac troponin (cTnT) and copeptin may have the potential to increase the diagnostic capabilities of prehospital providers. Multiple electronic databases (MAG Online Library, Cochrane Library, PubMed and Embase) were searched to evaluate the feasibility and potential application of cardiac biomarkers cTnT and copeptin in the prehospital setting. Because of the paucity of evidence, this article explores the evidence on the dual-marker strategy of cTnT and copeptin to increase diagnostic capabilities of prehospital providers, and as an adjunct for decision-making and risk stratification for AMI. The evidence suggests that using the combined dual-marker strategy of cTnT and copeptin may counteract limitations of the ‘troponin-blind’ period of cTnT and the low cardiac specificity of copeptin. However, the research for this method is still in its infancy and requires investigation into its feasibility and affordability as well as into the training required to implement it in paramedic practice.

The prehospital landscape is unrecognisable from how it was 30 years ago and could be poised for a dramatic shift towards rapid diagnostic capabilities for paramedics, with point-of-care (PoC) biomarker testing.

The challenge for paramedic practice is its heavy reliance upon prehospital electrocardiography and patient symptomology to diagnose acute myocardial infarction (AMI), which may delay treatment and definitive care (Chacko et al, 2018). PoC cardiac biomarkers could be the missing link to resolve diagnostic uncertainties of AMI and subsequent decision-making in paramedic practice (Pedersen et al, 2019).

This article explores and discusses the value of introducing PoC dual-marker testing (cardiac troponin-T (cTnT) and copeptin) as an adjunct to aid diagnosis and decision-making for treatment and triage of AMI in UK paramedic practice. The cost-effectiveness, feasibility and the future of this technology will also be discussed.

Preliminary searching of the extent of the literature determined that the body of evidence surrounding cardiac biomarkers in the prehospital setting was limited. Because the literature was so sparse, a generalised exploration of the literature was performed to evaluate the feasibility and potential application of cardiac biomarkers in the prehospital setting.

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Acute myocardial infarction
Biomarkers
Cardiac troponin
Copeptin
Point-of-care testing
Prehospital diagnosis
Cardiology