Journal article
Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction.
- Rubini Giménez M Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network3Emergency Department, Centro de Investigación Biomédica en Red Enfermedades Respiratorias Instituto de Salud Carlos III, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
- Twerenbold R Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Boeddinghaus J Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Nestelberger T Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Puelacher C Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Hillinger P Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Wildi K Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Jaeger C Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Grimm K Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Heitzelmann KF Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Sabti Z Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Badertscher P Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Cupa J Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Honegger U Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Schaerli N Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Kozhuharov N Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- du Fay de Lavallaz J Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Lopez B Global Research in Acute Conditions Network4Emergency Department, Hospital Clinic, Barcelona, Spain.
- Salgado E Global Research in Acute Conditions Network4Emergency Department, Hospital Clinic, Barcelona, Spain.
- Miró Ò Global Research in Acute Conditions Network4Emergency Department, Hospital Clinic, Barcelona, Spain.
- Martín-Sánchez FJ Emergency Department, Hospital Clinic San Carlos, Madrid, Spain.
- Adrada ER Emergency Department, Hospital Clinic San Carlos, Madrid, Spain.
- Morawiec B Second Cardiology Department, Zabrze, University of Silesia, Katowice, Poland.
- Parenica J Department of Cardiology, University Hospital, Brno, Czech Republic.
- Ganovska E Department of Cardiology, University Hospital, Brno, Czech Republic.
- Neugebauer C Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Rentsch K Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
- Lohrmann J Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Osswald S Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- Reichlin T Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- Mueller C Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
- 2016-09-23
Published in:
- JAMA cardiology. - 2016
Aged
Biomarkers
Female
Humans
Male
Middle Aged
Myocardial Infarction
Prospective Studies
Sensitivity and Specificity
Troponin T
English
Importance
It is currently unknown whether the uniform (universal clinical practice for more than 2 decades) or 2 sex-specific cutoff levels are preferable when using high-sensitivity cardiac troponin T (hs-cTnT) levels in the diagnosis of acute myocardial infarction (AMI).
Objective
To improve the management of suspected AMI in women by exploring sex-specific vs uniform cutoff levels for hs-cTnT.
Design, Setting, and Participants
In an ongoing prospective, diagnostic, multicenter study conducted at 9 emergency departments, the present study evaluated patients enrolled from April 21, 2006, through June 5, 2013. The participants included 2734 adults presenting with suspected AMI. Duration of follow-up was 2 years, and data analysis occurred from June 5 to December 21, 2015.
Interventions
The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including measurements of serial hs-cTnT blood concentrations twice: once using the uniform 99th percentile cutoff value level of 14 ng/L and once using sex-specific 99th percentile levels of hs-cTnT (women, 9 ng/L; men, 15.5 ng/L).
Main Outcomes and Measures
Diagnostic reclassification in women and men using sex-specific vs the uniform cutoff level in the diagnosis of AMI.
Results
Of the 2734 participants, 876 women (32%) and 1858 men (68%) were included. Median (interquartile range) age was 68 (55-77) and 59 (48-71) years, respectively. With the use of the uniform cutoff value, 127 women (14.5%) and 345 men (18.6%) received a final diagnosis of AMI. Among these, at emergency department presentation, levels of hs-cTnT were already above the uniform cutoff value in 427 patients (sensitivity, 91.3% [95% CI, 85%-95.6%] in women vs 90.7% [95% CI, 87.1%-93.5% in men]; specificity, 79.2% [95% CI, 76.1%-82.1%] in women vs 78.5% [95% CI, 76.4%-80.6%] in men). After readjudication using sex-specific 99th percentile levels, diagnostic reclassification regarding AMI occurred in only 3 patients: 0.11% (95% CI, 0.02-0.32) of all patients and 0.6% (95% CI, 0.13-1.85) of patients with AMI. The diagnosis in 2 women was upgraded from unstable angina to AMI, and the diagnosis in 1 man was downgraded from AMI to unstable angina. These diagnostic results were confirmed when using 2 alternative pairs of uniform and sex-specific cutoff values.
Conclusions and Relevance
The uniform 99th percentile should remain the standard of care when using hs-cTnT levels for the diagnosis of AMI.
It is currently unknown whether the uniform (universal clinical practice for more than 2 decades) or 2 sex-specific cutoff levels are preferable when using high-sensitivity cardiac troponin T (hs-cTnT) levels in the diagnosis of acute myocardial infarction (AMI).
Objective
To improve the management of suspected AMI in women by exploring sex-specific vs uniform cutoff levels for hs-cTnT.
Design, Setting, and Participants
In an ongoing prospective, diagnostic, multicenter study conducted at 9 emergency departments, the present study evaluated patients enrolled from April 21, 2006, through June 5, 2013. The participants included 2734 adults presenting with suspected AMI. Duration of follow-up was 2 years, and data analysis occurred from June 5 to December 21, 2015.
Interventions
The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including measurements of serial hs-cTnT blood concentrations twice: once using the uniform 99th percentile cutoff value level of 14 ng/L and once using sex-specific 99th percentile levels of hs-cTnT (women, 9 ng/L; men, 15.5 ng/L).
Main Outcomes and Measures
Diagnostic reclassification in women and men using sex-specific vs the uniform cutoff level in the diagnosis of AMI.
Results
Of the 2734 participants, 876 women (32%) and 1858 men (68%) were included. Median (interquartile range) age was 68 (55-77) and 59 (48-71) years, respectively. With the use of the uniform cutoff value, 127 women (14.5%) and 345 men (18.6%) received a final diagnosis of AMI. Among these, at emergency department presentation, levels of hs-cTnT were already above the uniform cutoff value in 427 patients (sensitivity, 91.3% [95% CI, 85%-95.6%] in women vs 90.7% [95% CI, 87.1%-93.5% in men]; specificity, 79.2% [95% CI, 76.1%-82.1%] in women vs 78.5% [95% CI, 76.4%-80.6%] in men). After readjudication using sex-specific 99th percentile levels, diagnostic reclassification regarding AMI occurred in only 3 patients: 0.11% (95% CI, 0.02-0.32) of all patients and 0.6% (95% CI, 0.13-1.85) of patients with AMI. The diagnosis in 2 women was upgraded from unstable angina to AMI, and the diagnosis in 1 man was downgraded from AMI to unstable angina. These diagnostic results were confirmed when using 2 alternative pairs of uniform and sex-specific cutoff values.
Conclusions and Relevance
The uniform 99th percentile should remain the standard of care when using hs-cTnT levels for the diagnosis of AMI.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1001/jamacardio.2016.2882
- PMID 27653005
- Persistent URL
- https://sonar.ch/global/documents/109485
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