Effectiveness of Point-of-Care High-Sensitivity Troponin Testing in the Emergency Department: A Randomized Controlled Trial

Summary

WESTCOR randomized 1,494 ED patients with possible ACS to 0/1-hour point-of-care hs-cTnI or centralized 0/1-hour hs-cTnT testing. Median ED length of stay was 174 versus 180 minutes, a 6-minute reduction (95% CI -4 to 17), below the prespecified 15-minute clinically meaningful difference. Thirty-day MI, death, or acute revascularization occurred in 11.4% versus 9.4%, with no detected difference in the prespecified safety follow-up.

Why it matters

Point-of-care hs-troponin alone did not meaningfully shorten ED stay in this workflow, so adopting a bedside assay should not be assumed to improve throughput without redesigning the surrounding diagnostic pathway. The studied 0/1-hour regimen remains assay- and system-specific.

Main findings

• Median ED length of stay was 174 minutes with point-of-care testing versus 180 minutes with centralized testing; difference 6 minutes (95% CI -4 to 17).
• The observed throughput difference did not meet the prespecified 15-minute clinically meaningful threshold.
• Thirty-day MI, death, or acute revascularization occurred in 83/728 (11.4%) versus 72/766 (9.4%); no difference was detected.
• The primary abstract did not report a separate adverse-event profile beyond clinical outcome follow-up.

Limitations

Single-center trial comparing different hs-troponin assays as well as different testing locations, with workflow-dependent effects and insufficient precision to establish equivalence for clinical events. Later implementation evidence suggests that operational context materially modifies throughput benefit.