Prehospital Troponin T testing in patients with suspected acute myocardial infarction

This study set out to examine both the feasibility of point-of-care biomarker testing by paramedics -specifically prehospital Troponin T (TnT), and its diagnostic value in prehospital patients with suspected AMI.

From June 2008 through to September 2009, 4905 patients with suspected acute coronary syndrome were encountered but only 958 patients were tested; the others were not included due to limited availability of paramedics trained in qualitative TnT testing and/or lack of available equipment.

Hospital diagnosis of AMI was established in 208 of these patients, of which only 30% were identified during prehospital testing as opposed to a 79% detection rate from the first in-hospital test when TnT was measured quantitatively.

Some of the study's limitations include the testing of only 958 out of a possible 4,05 patients; the use of in-hospital quantitative TnT measurements to validate prehospital qualitative TnT readings as the samples were tested at different times and by different mechanisms.

The findings highlight that while paramedics can successfully carry out the procedure, the diagnostic value of qualitative troponin measurement may be limited (full discussion is beyond the scope of this review).