Abstract
INTRODUCTION: Chest pain is one of the most common conditions presenting to emergency departments (EDs), with over 1.3 million attendances according to 2022/2023 UK data. The diagnosis of a myocardial infarction (MI) in pre-hospital settings is challenging, relying on careful history taking and electrocardiograms. Patients with ST elevation are transferred to hospitals with primary percutaneous coronary intervention (PPCI) facilities, whereas those without ST elevation are taken to local EDs for further work-up, including troponin testing. Point-of-care (POC) troponin tests are now available in the field, presenting the potential to diagnose MI in patients without ST elevation. This systematic review aims to investigate and determine whether POC troponin devices are effective in detecting patients with acute MI in the pre-hospital setting. METHODS: This systematic review was performed in accordance with the PRISMA guidelines. A comprehensive search of the literature was created using the following databases: CINAHL, MEDLINE, EMBASE and DISCOVERY. Basic and advanced search strategies were used to identify papers using POC troponin testing in patients presenting in the pre-hospital setting with chest pain. RESULTS: A total of five articles were identified demonstrating that a variety of pre-hospital POC troponin testing devices can detect MI in patients presenting with chest pain. One limitation of POC testing was that some patients with negative troponin results in the pre-hospital setting were confirmed to have MI in the hospital setting. CONCLUSION: Using POC troponin raises the possibility of detecting an MI, but cannot definitively exclude an MI. Further research is required to investigate the reliability of POC troponin testing in cohorts without ST elevation in the pre-hospital environment, which may expedite transfer to specialised PPCI hospitals over a local ED. The outcome of further research has the potential to positively impact outcomes of patients suffering with MI and to yield financial benefits via faster, more effective treatment.