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High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study.

Shah, ASV; Griffiths, M; Lee, KK; McAllister, DA; Hunter, AL; Ferry, AV; Cruikshank, A; Reid, A; Stoddart, M; Strachan, F; et al. Shah, ASV; Griffiths, M; Lee, KK; McAllister, DA; Hunter, AL; Ferry, AV; Cruikshank, A; Reid, A; Stoddart, M; Strachan, F; Walker, S; Collinson, PO; Apple, FS; Gray, AJ; Fox, KAA; Newby, DE; Mills, NL (2015) High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ, 350. g7873. ISSN 1756-1833 https://doi.org/10.1136/bmj.g7873
SGUL Authors: Collinson, Paul

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Abstract

OBJECTIVE: To evaluate the diagnosis of myocardial infarction using a high sensitivity troponin I assay and sex specific diagnostic thresholds in men and women with suspected acute coronary syndrome. DESIGN: Prospective cohort study. SETTING: Regional cardiac centre, United Kingdom. PARTICIPANTS: Consecutive patients with suspected acute coronary syndrome (n=1126, 46% women). Two cardiologists independently adjudicated the diagnosis of myocardial infarction by using a high sensitivity troponin I assay with sex specific diagnostic thresholds (men 34 ng/L, women 16 ng/L) and compared with current practice where a contemporary assay (50 ng/L, single threshold) was used to guide care. MAIN OUTCOME MEASURE: Diagnosis of myocardial infarction. RESULTS: The high sensitivity troponin I assay noticeably increased the diagnosis of myocardial infarction in women (from 11% to 22%; P<0.001) but had a minimal effect in men (from 19% to 21%, P=0.002). Women were less likely than men to be referred to a cardiologist or undergo coronary revascularisation (P<0.05 for both). At 12 months, women with undisclosed increases in troponin concentration (17-49 ng/L) and those with myocardial infarction (≥50 ng/L) had the highest rate of death or reinfarction compared with women without (≤16 ng/L) myocardial infarction (25%, 24%, and 4%, respectively; P<0.001). CONCLUSIONS: Although having little effect in men, a high sensitivity troponin assay with sex specific diagnostic thresholds may double the diagnosis of myocardial infarction in women and identify those at high risk of reinfarction and death. Whether use of sex specific diagnostic thresholds will improve outcomes and tackle inequalities in the treatment of women with suspected acute coronary syndrome requires urgent attention.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/. Errata available at https://doi.org/10.1136/bmj.h626 and https://doi.org/10.1136/bmj.i4840
Keywords: Acute Coronary Syndrome, Aged, Aged, 80 and over, Biomarkers, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, ROC Curve, Reference Values, Sensitivity and Specificity, Sex Factors, Troponin I, Humans, Myocardial Infarction, Troponin I, Sensitivity and Specificity, Prospective Studies, ROC Curve, Sex Factors, Reference Values, Aged, Aged, 80 and over, Middle Aged, Female, Male, Acute Coronary Syndrome, Biomarkers, General & Internal Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: BMJ
ISSN: 1756-1833
Language: eng
Dates:
DateEvent
21 January 2015Published
30 December 2014Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
103782Wellcome Trusthttp://dx.doi.org/10.13039/100004440
FS/10/024/28266British Heart Foundationhttp://dx.doi.org/10.13039/501100000274
SP/12/10/29922British Heart Foundationhttp://dx.doi.org/10.13039/501100000274
SS/CH/09/002British Heart Foundationhttp://dx.doi.org/10.13039/501100000274
CH/09/002British Heart Foundationhttp://dx.doi.org/10.13039/501100000274
PubMed ID: 25609052
Web of Science ID: WOS:000348433700001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108954
Publisher's version: https://doi.org/10.1136/bmj.g7873

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