Diagnostic Accuracy of the Initial Point-of-Care Troponin Tests for Patients With Chest Pain Who Were Suspected of Acute Myocardial Infarction　- A Systematic Review and Meta-Analysis.

Background: Point-of-care (POC) cardiac troponin testing, although less sensitive than high-sensitivity cardiac troponin assays, allows for rapid bedside evaluation. This study assessed the diagnostic performance of POC troponin tests for both ruling in and ruling out acute myocardial infarction (AMI) at the time of patient presentation. Methods and Results: In accordance with PRISMA-DTA guidelines, we conducted a systematic review and meta-analysis using PubMed, Web of Science, and the Cochrane Library from inception through June 17, 2023. We included all studies evaluating the diagnostic accuracy of POC troponin assays for identifying AMI among adult patients. Among the 551 studies initially screened, 6 met the eligibility criteria for inclusion. A meta-analysis of diagnostic accuracy based on these 6 observational datasets demonstrated pooled sensitivity and specificity values of 47% (95% confidence interval (CI) 45-49%) and 90% (95% CI 89-90%), respectively, for AMI detection. In a subgroup meta-analysis of non-ST-segment elevation MI using 4 observational datasets, the pooled sensitivity and specificity were 48% (95% CI 45-50%) and 89% (95% CI 89-90%), respectively. Conclusions: These findings emphasize that the clinical application of POC troponin assays in AMI diagnosis must consider the test's robust specificity (≈90%) alongside its limited sensitivity (<50%).