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

Anoop S V Shah; Megan Griffiths; Kuan Ken Lee; David A McAllister; Amanda L Hunter; Amy V Ferry; Anne Cruikshank; Alan Reid; Mary Stoddart; Fiona Strachan; Simon Walker; Paul O Collinson; Fred S Apple; Alasdair J Gray; Keith A A Fox; David E Newby; Nicholas L Mills

doi:10.1136/bmj.g7873

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

Anoop S V Shah, Megan Griffiths, Kuan Ken Lee, David A McAllister, Amanda L Hunter, Amy V Ferry, Anne Cruikshank, Alan Reid, Mary Stoddart, Fiona Strachan, Simon Walker, Paul O Collinson, Fred S Apple, Alasdair J Gray, Keith A A Fox, David E Newby, Nicholas L Mills^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	g7873
Number of pages	8
Journal	British Medical Journal (BMJ)
Volume	350
Issue number	7992
DOIs	https://doi.org/10.1136/bmj.g7873
Publication status	Published - 21 Jan 2015

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

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HIGH SENSITIVE TROPONIN ASSAY IN THE EVALUATION OF PATIENTS WITH ACUTE CORONARY SYNDROME (HighSTEACS): A RANDOMISED CONTROLLED TRIAL
Mills, N.
UK-based charities
1/10/12 → 30/09/17
Project: Research

1 Comment/debate

Errata - High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
Shah, A., Griffiths, M., Lee, K. K., McAllister, D., Hunter, A. L., Ferry, A. V., Cruikshank, A., Reid, A., Stoddart, M., Strachan, F., Walker, S., Collinson, P. O., Apple, F. S., Gray, A., Fox, K., Newby, D. & Mills, N., 3 Feb 2015, In: British Medical Journal (BMJ). 350, p. h626
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£5 blood test could detect twice as many heart attacks in women, finds study by Dr Anoop Shah
Anoop Shah
21/01/15
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Dr Nicholas Mills develops test to diagnose hearts attacks in women
Nicholas Mills
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Dr Nicholas Mills helps to develop a simple, cheap heart attack test
Nicholas Mills
19/06/14
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Nicholas Mills
- nick.mills@ed.ac.uk
- Deanery of Clinical Sciences - Personal Chair of Cardiology
- Centre for Cardiovascular Science
- Edinburgh Imaging
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Shah, A. S. V., Griffiths, M., Lee, K. K., McAllister, D. A., Hunter, A. L., Ferry, A. V., Cruikshank, A., Reid, A., Stoddart, M., Strachan, F., Walker, S., Collinson, P. O., Apple, F. S., Gray, A. J., Fox, K. A. A., Newby, D. E., & Mills, N. L. (2015). High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. British Medical Journal (BMJ), 350(7992), [g7873]. https://doi.org/10.1136/bmj.g7873

Shah, Anoop S V ; Griffiths, Megan ; Lee, Kuan Ken ; McAllister, David A ; Hunter, Amanda L ; Ferry, Amy V ; Cruikshank, Anne ; Reid, Alan ; Stoddart, Mary ; Strachan, Fiona ; Walker, Simon ; Collinson, Paul O ; Apple, Fred S ; Gray, Alasdair J ; Fox, Keith A A ; Newby, David E ; Mills, Nicholas L. / High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. In: British Medical Journal (BMJ). 2015 ; Vol. 350, No. 7992.

@article{4ad27803a08a49868b3b21aa2ed9694a,

title = "High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study",

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.",

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",

author = "Shah, {Anoop S V} and Megan Griffiths and Lee, {Kuan Ken} and McAllister, {David A} and Hunter, {Amanda L} and Ferry, {Amy V} and Anne Cruikshank and Alan Reid and Mary Stoddart and Fiona Strachan and Simon Walker and Collinson, {Paul O} and Apple, {Fred S} and Gray, {Alasdair J} and Fox, {Keith A A} and Newby, {David E} and Mills, {Nicholas L}",

note = "{\textcopyright} Shah et al 2015.",

year = "2015",

month = jan,

day = "21",

doi = "10.1136/bmj.g7873",

language = "English",

volume = "350",

journal = "British Medical Journal (BMJ)",

issn = "0959-8138",

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number = "7992",

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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', British Medical Journal (BMJ), vol. 350, no. 7992, g7873. https://doi.org/10.1136/bmj.g7873

High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. / Shah, Anoop S V; Griffiths, Megan; Lee, Kuan Ken; McAllister, David A; Hunter, Amanda L; Ferry, Amy V; Cruikshank, Anne; Reid, Alan; Stoddart, Mary; Strachan, Fiona; Walker, Simon; Collinson, Paul O; Apple, Fred S; Gray, Alasdair J ; Fox, Keith A A ; Newby, David E ; Mills, Nicholas L.

In: British Medical Journal (BMJ), Vol. 350, No. 7992, g7873, 21.01.2015.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study

AU - Shah, Anoop S V

AU - Griffiths, Megan

AU - Lee, Kuan Ken

AU - McAllister, David A

AU - Hunter, Amanda L

AU - Ferry, Amy V

AU - Cruikshank, Anne

AU - Reid, Alan

AU - Stoddart, Mary

AU - Strachan, Fiona

AU - Walker, Simon

AU - Collinson, Paul O

AU - Apple, Fred S

AU - Gray, Alasdair J

AU - Fox, Keith A A

AU - Newby, David E

AU - Mills, Nicholas L

PY - 2015/1/21

Y1 - 2015/1/21

N2 - 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.

AB - 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.

KW - Acute Coronary Syndrome

KW - Aged

KW - Aged, 80 and over

KW - Biomarkers

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Prospective Studies

KW - ROC Curve

KW - Reference Values

KW - Sensitivity and Specificity

KW - Sex Factors

KW - Troponin I

U2 - 10.1136/bmj.g7873

DO - 10.1136/bmj.g7873

M3 - Article

C2 - 25609052

AN - SCOPUS:84921770937

VL - 350

JO - British Medical Journal (BMJ)

JF - British Medical Journal (BMJ)

SN - 0959-8138

IS - 7992

M1 - g7873

ER -

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

Abstract

Keywords

Access to Document

HIGH SENSITIVE TROPONIN ASSAY IN THE EVALUATION OF PATIENTS WITH ACUTE CORONARY SYNDROME (HighSTEACS): A RANDOMISED CONTROLLED TRIAL

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

£5 blood test could detect twice as many heart attacks in women, finds study by Dr Anoop Shah

Dr Nicholas Mills develops test to diagnose hearts attacks in women

Dr Nicholas Mills helps to develop a simple, cheap heart attack test

Nicholas Mills

Cite this