Background: We aimed to prospectively evaluate the safety and efficacy of the new ESC rapid 0h/3h-rule-out protocol for AMI based on the 99th percentile of high sensitivity cardiac troponins (hs-cTn), among women and men in order to assess potential gender-inequalities.

Methods: We enrolled consecutive patients presenting to the ED with suspected AMI in a prospective international multicenter study. Excluded were patients with ST-segment elevation, no available baseline hs-cTnT levels, and no available data about onset/peak of pain. Among the remaining 2727 patients, 32% were women and 68% men. The final diagnosis was adjudicated by two independent cardiologists. The safety and efficacy of the ESC 0h/3h-rule-out protocol was evaluated among women and men.

Results: AMI was the final diagnosis in 17% of patient (15% of women and 19% of men (p<0.001)). Using the 99th percentile of hs-cTnT (14ng/l), the ESC 0h-rule-out protocol correctly ruled-out 99.4% (95% CI, 96.8–100%) of late presenters (≥6h from chest pain onset) among women and 100% (95% CI, 99.8–100%) among men (p=ns). The ESC 3h-rule-out protocol correctly ruled-out 100% (95% CI 98.3–100%) of early presenters (<6h from chest pain onset) among women and 99.8% (95% CI, 98.9–100%) among men (p=ns). Overall, the ESC rule-out protocol classified about 44% of women and 43% of men with suspected AMI.

Conclusions: The current ESC 0h/3h-rule-out protocol using the 99th percentile of hs-cTn in conjunction with clinical assessment is safe and effective and provides comparable results among women and men. A common strategy for both genders seems to be the most appropriate choice.