National academy of clinical biochemistry laboratory medicine practice guidelines: Point of care testing, oversight, and administration of cardiac biomarkers for acute coronary syndromes

Guidelines for the preanalytical, analytical, and postanalytical phases of cardiac biomarker testing at point of care (POC) are presented. At initiation, stakeholders including emergency medicine, cardiology, primary care, and laboratory medicine should work collaboratively to develop systems for the evaluation of patients with possible acute coronary syndrome. These stakeholders should work with administrators to develop evidence-based guidelines and quality assurance measures aimed at reducing medical errors. Technically, the specimen should be plasma or anticoagulated whole blood; time of collection should be referenced to patient presentation. Analytical performance specifications for POC measurement must not differ from the central laboratory. The turnaround time from blood collection to result reporting should be 30 minutes or less; institutions that cannot consistently deliver results in less than 1 hour should implement POC testing. It is expected that technology will continue to evolve in the area of cardiac biomakers, with the involvement of professional organizations early in the process of implementing new analytes, so that standardization and reporting can be addressed at an early phase.