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Impact of sex-specific cut-off values of high-sensitivity troponin t on the prevalence of acute myocardial infarction

Session Poster session 1

Speaker Maria Rubini Gimenez

Event : ESC Congress 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Session type : Poster Session

Authors : M Rubini Gimenez (Basel,CH), R Twerenbold (Basel,CH), K Wildi (Basel,CH), T Reichlin (Basel,CH), T Nestelberger (Basel,CH), K Grimm (Basel,CH), P Hillinger (Basel,CH), M Wagener (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
M. Rubini Gimenez1 , R. Twerenbold1 , K. Wildi1 , T. Reichlin1 , T. Nestelberger1 , K. Grimm1 , P. Hillinger1 , M. Wagener1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 78-79

Background: The use of sex-specific reference values for cardiac troponins is in discussion. The 99th percentile of hs-cTn assays in healthy individuals was found to be significantly lower in women as compared to men, possibly at least in part related to the smaller size of women's hearts. These recent findings question current clinical practice to use identical cut-off values fort the diagnosis of acute myocardial infarction (AMI) in men and women.

Methods: We enrolled 2843 consecutive patients presenting with suspected acute chest pain to the emergency department in an ongoing prospective international multicenter study. Patients with STEMI (n=108) have been excluded from analysis. The final diagnosis was adjudicated by two independent cardiologists using all available information including serial high-sensitivity troponin T (hs-cTnT) levels with a 99th percentile cutoff value of 14 ng/L. We adjudicated a second final diagnosis using sex-specific 99th percentiles of hs-cTnT (women 8.9ng/L, men 15.5 ng/L).

Results: There were n=876 women (32%) in the cohort. Using the same cutoff value for both women and men, 14.5% (n=127) females and 18.6% (n=346) males received the final diagnosis of Non ST segment elevation infarction (NSTEMI). 5.6% (n=49) females and 12.2% (n=226) males received the final the diagnosis of Unstable Angina (UA).

Using gender-specific cutoffs 2 women were shifted from the diagnosis of UA to NSTEMI. One man received the final diagnosis of UA instead of NSTEMI.

Conclusions: In our cohort, there was little impact of sex-specific reference values for hs-cTnT. Gender-specific cut-off values of hs-cTn seem to be not necessary for the diagnosis of AMI.

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