Türk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - WESTCOR-POC - Point of care versus centralised high-sensitivity cardiac troponin in the emergency department (Dr. Kıvanç Eren)

[Türkçe]

Turkish Society of Cardiology Young Cardiologists Bulletin Year: 7 Number: 5 / 2024

Turkish Society of Cardiology
Young Cardiologists
President
Dr. Muzaffer Değertekin

Coordinator for the
Board of Directors
Dr. Ertuğrul Okuyan

Coordinator for the
Board of Directors
Dr. Can Yücel Karabay

Members
Dr. Adem Aktan
Dr. Gülşah Aktüre
Dr. Bayram Arslan
Dr. İnanç Artaç
Dr. Ahmet Oğuz Aslan
Dr. Görkem Ayhan
Dr. Ahmet Anıl Başkurt
Dr. Özkan Bekler
Dr. Oğuzhan Birdal
Dr. Yusuf Bozkurt Şahin
Dr. Serkan Bulgurluoğlu
Dr. Ümit Bulut
Dr. Veysi Can
Dr. Mustafa Candemir
Dr. Murat Çap
Dr. Göksel Çinier
Dr. Ali Çoner
Dr. Yusuf Demir
Dr. Ömer Furkan Demir
Dr. Murat Demirci
Dr. Ayşe İrem Demirtola Mammadli
Dr. Süleyman Çağan Efe
Dr. Mehmet Akif Erdöl
Dr. Kubilay Erselcan
Dr. Kerim Esenboğa
Dr. Duygu Genç
Dr. Kemal Göçer
Dr. Elif Güçlü
Dr. Arda Güler
Dr. Duygu İnan
Dr. Hasan Burak İşleyen
Dr. Muzaffer Kahyaoğlu
Dr. Sedat Kalkan
Dr. Yücel Kanal
Dr. Özkan Karaca
Dr. Ahmet Karaduman
Dr. Mustafa Karanfil
Dr. Ayhan Kol
Dr. Fatma Köksal
Dr. Mevlüt Serdar Kuyumcu
Dr. Yunus Emre Özbebek
Dr. Ahmet Özderya
Dr. Yasin Özen
Dr. Ayşenur Özkaya İbiş
Dr. Çağlar Özmen
Dr. Selvi Öztaş
Dr. Hasan Sarı
Dr. Serkan Sivri
Dr. Ali Uğur Soysal
Dr. Hüseyin Tezcan
Dr. Nazlı Turan
Dr. Berat Uğuz
Dr. Örsan Deniz Urgun
Dr. İdris Yakut
Dr. Mustafa Yenerçağ
Dr. Mehmet Fatih Yılmaz
Dr. Yakup Yiğit
Dr. Mehmet Murat Yiğitbaşı

Bulletin Editors
Dr. Muzaffer Değertekin
Dr. Can Yücel Karabay
Dr. Muzaffer Kahyaoğlu
Dr. Ahmet Karaduman

Contributors
Dr. Ahmet Karaduman
Dr. Berkant Öztürk
Dr. Burak Kardeşler
Dr. Kıvanç Eren
Dr. Mehmet Aydoğan
Dr. Murat Demirci
Dr. Murat Yiğitbaşı
Dr. Mustafa Candemir
Dr. Mustafa Lütfi Yavuz
Dr. Mustafa Yenerçağ
Dr. Ravza Betül Akbaş
Dr. Selvi Öztaş
Dr. Serkan Bulgurluoğlu
Dr. Yunus Çalapkulu
Dr. Yusuf Bozkurt

WESTCOR-POC - Point of care versus centralised high-sensitivity cardiac troponin in the emergency departmentTürk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - WESTCOR-POC - Point of care versus centralised high-sensitivity cardiac troponin in the emergency department (Dr. Kıvanç Eren)Dr. Kıvanç Eren Name of the Study: WESTCOR-POC - Point of care versus centralised high-sensitivity cardiac troponin in the emergency department This summary is based on the presentation of Doctor Viola Thulin (Haukeland University Hospital - Bergen, Norway) at the ESC Congress 2024 Background: Chest pain is the leading cause of hospitalization worldwide. Majority of the patients who present with chest pain have prolonged hospitalization during which they undergo testing the rule out acute coronary syndrome (ACS). Most of the time the patients are hospitalized and tested in the emergency department (ED) to rule out ACS. After prolonged hospital stay and testing, 60-70% of the patients are found to have benign cause of chest pain like acid reflux. Overcrowding of the ED is a concerning global problem and is associated with increased mortality. Conventional ACS testing consists of central laboratory testing for high sensitive cardiac troponin (hs-cTn) at presentation and again 1-3 hours later. The turnaround time for hs-cTn is around 60 minutes. Point of care testing (POC), tests for hs-cTn (Atellica VTLi, Siemens Healthineers) for suspected ACS patients with a turnaround time of just 8 minutes. Accelerated diagnostic testing is needed to rule out ACS and safely discharge low-risk chest pain patients. The POC test had previously been shown to have similar accuracy and precision to standard central laboratory testing. Use of POC tests for suspected ACS patients in the ED could significantly shorten hospital stay and improve patient care. Methods: WESTCOR-POC trial was conducted at Haukeland University Hospital in Norway. 1494 adult patients who presented to ED with symptoms indicative of possible ACS were included in the study. Patients were randomly and equally divided into 2 groups. Novel POC testing group (n=728) were tested for cardiac markers using the novel point of care testing and standard central lab testing group (n=766) received conventional central laboratory testing for cardiac markers. Patient characteristics were similar between the two groups and patients were admitted or discharged based on the judgement of the attending physician. The primary end point of study was the median length of hospitalization in the ED with sub-analyses done for patients who were seen by a physician within 60 minutes of presentation and also for patients who were diagnosed with non-ST segment elevation myocardial infarction. Secondary endpoints were composite rates of all-cause mortality, myocardial infarction and acute revascularization. Percentage of patients discharged and total length of hospital stay were also investigated between the two groups. Results: Median length of hospitalization in the ED was 6 minutes shorter in the POC testing group. 174 minutes for POC testing group and 180 minutes for the central lab testing group. Sub-analyses revelead that patients who were seen by a physician more quickly (within 60 minutes), the median length of hospitalization in the ED was 15 minutes shorter in POC testing group compared to central lab testing group. Notably, POC testing provided the most benefit in patients who were diagnosed with non-ST segment elevation myocardial infarction, reducing the length of stay in ED by 43 minutes on average compared to central lab testing group (median 137 minutes vs 180 minutes). Total length of hospital stay and the percentage of patients discharged within 3 hours and within 6 hours were similar between the two groups. POC testing also showed to be just as safe as conventional laboratory testing. Rates of combined all cause mortality, myocardial infarctions and acute revascularization within 30 days following discharge were similar between the two groups. Interpretations: Novel 8-minute (POC) heart attack test is safe and substantially reduces length of stay in the emergency department (ED) for patients seen quickly by a physician and those diagnosed with non-STEMI heart attack compared to central laboratory testing. POC troponin assays hold great promise to improve patient care. But our findings underscore the need for a process to map out and address obstacles to efficient patient flow, such as lack of relevant staff or lack of efficient discharge procedures, to realize the full potential of POC tests to manage chest pain patients in the emergency department.