Consensus Guidelines | Interpretation of Expert Consensuses on Point-of-Care Testing (POCT) for Chest Pain and Cardiac Markers

This consensus aims to standardize and optimize the emergency care system for chest pain, providing significant practical value in improving diagnostic levels and patient outcomes.

Interpretation of Diagnostic Content

1. Acute Chest Pain as a Heterogeneous Clinical Group: Acute chest pain is one of the most common clinical symptoms, representing a group of heterogeneous diseases. Community healthcare and pre-hospital emergency care serve as the starting points for life-saving interventions and are critical for "extending the diagnostic front-line." Training pre-hospital teams in rapid identification, early management, and triaging—supported by information technology—can significantly enhance emergency response capabilities.
2. Rapid Risk Stratification: Given the diverse etiologies of chest pain, immediate risk assessment is mandatory. This involves:
   • Establishing triage strategies for acute non-traumatic chest pain.
   • Rapidly identifying life-threatening conditions.
   • Synthesizing clinical data to diagnose and evaluate low-to-moderate risk cases.
3. Diagnostic Adjuncts: All chest pain patients should receive an electrocardiogram (ECG) within 10 minutes of first medical contact (FMC), followed by dynamic observation. Based on suspected diagnoses, clinicians should select tests such as Troponin, D-Dimer, Natriuretic Peptides (BNP/NT-proBNP), blood gas analysis, coagulation profiles, and biochemistry. Imaging modalities (ultrasound, X-ray, CT, CTA) are also vital; specifically, "Chest Pain Triple-Rule-Out CTA" can simultaneously differentiate between Acute Coronary Syndrome (ACS), Acute Aortic Dissection (AAD), and Acute Pulmonary Embolism (APE).

This consensus drives the standardization of POCT applications to ensure patient safety and enhance laboratory quality management.

Key Interpretations

• Clinical Utility: POCT is characterized by its speed, miniaturization, and portability. Standardizing the reporting and release procedures is essential for ensuring patient safety and enhancing laboratory quality management.
• Reporting Requirements: POCT reports should follow the Administrative Measures for Clinical Laboratories in Medical Institutions. While prioritizing speed, the accuracy and integrity of the information must be maintained. Templates must include patient demographics, test data, operator details, timestamps, and any special clinical circumstances.
• Management Procedures: There must be documented procedures for result authorization, interpretation, and the handling of critical values. Medical institutions should establish dedicated critical value thresholds for POCT. Results must be archived in electronic or paper medical records to ensure legal validity.

This consensus focuses on the clinical application and quality management of cTn and BNP/NT-proBNP via POCT.

Key Interpretations

• Clinical Recommendations: International guidelines recommend using Cardiac Troponin (cTn) and B-type Natriuretic Peptide (BNP)/N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) for the diagnosis, differential diagnosis, and risk stratification of ACS and heart failure. POCT facilitates immediate reporting regardless of location.
• Initial Diagnostic Tool: The consensus prioritizes high-sensitivity and high-specificity POCT technologies as initial diagnostic tools. However, to prevent clinical errors resulting from compromised accuracy for the sake of speed, rigorous quality management is required.
• Deployment and Turnaround: POCT equipment should be standard in ERs, Triage, ICU, CCU, and internal medicine departments. For primary clinics or community hospitals, results should be delivered within 20 minutes.
• Methodology: Quantitative methods such as Enzyme-Linked Immunosorbent Assay (ELISA), Immunofluorescence, or Chemiluminescence are recommended. Platforms should support whole blood and plasma and integrate with Laboratory Information System (LIS).
• Performance Metrics: Manufacturers must establish their own 99th percentile Upper Reference Limits (URL) for healthy populations. For cTn, the Coefficient of Variation (CV) at the 99th percentile should be ≤ 10%.
• Quality Control: Daily internal quality control (IQC) at two concentration levels is required. Equipment must also participate in external quality assessment (EQA) programs organized by national or provincial clinical laboratory centers.

This consensus aims to improve the efficiency and quality of emergency care through standardized POCT.

Key Interpretations

• Evidence-Based Grading: Recommendations are based on the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation), categorized into strong, moderate, and weak recommendations.
• Green Channel Integration: The consensus strongly recommends integrating cardiac marker POCT into "green channels" for chest pain, particularly in primary and remote healthcare settings.
• Cerebrovascular Application: POCT for coagulation is vital for early treatment decisions in stroke patients. Elevated BNP levels may suggest a cardioembolic origin for ischemic strokes.
• Infection and Inflammation: POCT for CRP, PCT, and IL-6 assists in differential diagnosis and monitoring. IL-6 rapid testing is specifically highlighted for clinical decision-making in sepsis and cytokine storms.
• Special Populations: For women of childbearing age with abdominal pain/syncope, rapid β-hCG, glucose, and hemoglobin tests are recommended. Cardiac markers can also assist in managing hypertensive emergencies in pregnancy.
• Quality Assurance: Regular maintenance, calibration, and LIS/EMR integration are mandatory for emergency POCT.