Uniform or Sex-Specific Cardiac Troponin Thresholds to Rule-out Myocardial Infarction at Presentation

Ziwen Li, Ryan Wereski, Atul Anand, Matthew TH. Lowry, Dimitrios Doudesis, Michael Mcdermott, Amy V. Ferry, Christopher Tuck, Andrew R. Chapman, Kuan ken Lee, Anoop SV. Shah, Nicholas L. Mills, Dorien M. Kimenai, Olawale Mathias Akinlade, Stephanie Barker, Jennifer Blades, Jasper Boeddinghaus, Anda Bularga, Marie De Bakker, Andrew R. ChapmanDimitrios Doudesis, Amy V. Ferry, Takeshi Fujisawa, Konstantin Georgiev, Dorien M. Kimenai, Kuan Ken Lee, Iona Lyell, Ziwen Li, Matthew TH. Lowry, Lynn Mckinlay, Michael Mcdermott, Jean Mcpherson, Filip Mendusic, Nicholas L. Mills, Andrew Sorbie, Grace Souter, Stacey D. Schulberg, Caelan Taggart, Christopher Tuck, Alexander JF. Thurston, Yong Yong Tew, Daniel Perez-Vicencio, Yiqing Wang, Ryan Wereski, Kelly Williams, Nicholas L. Mills, David E. Newby, Keith AA. Fox, Colin Berry, Simon Walker, Christopher J. Weir, Ian Ford, Nicholas L. Mills, David E. Newby, Alasdair Gray, Keith AA. Fox, Colin Berry, Simon Walker, Paul O. Collinson, Fred S. Apple, Alan Reid, Anne Cruikshank, Iain Findlay, Shannon Amoils, David A. Mcallister, Donogh Maguire, Jennifer Stevens, John Norrie, Christopher J. Weir, Anoop SV. Shah, Atul Anand, Andrew R. Chapman, Kuan Ken Lee, Jack PM. Andrews, Philip D. Adamson, Alastair Moss, Mohamed S. Anwar, John Hung, Nicholas L. Mills, Simon Walker, Jonathan Malo, Alan Reid, Anne Cruikshank, Paul O. Collinson, Colin M. Fischbacher, Bernard L. Croal, Stephen J. Leslie, Catriona Keerie, Richard A. Parker, Allan Walker, Ronnie Harkess, Christopher Tuck, Tony Wackett, Christopher Weir, Roma Armstrong, Laura Stirling, Claire Macdonald, Imran Sadat, Frank Finlay, Kathy Harrison, Atul Anand, Pamela Linksted, Stephen Lavenberg, Nicholas L. Mills, Christopher Tuck, Atul Anand, Stephanie Barker, Jennifer Blades, Jasper Boeddinghaus, Anda Bularga, Andrew R. Chapman, Dimitrios Doudesis, Amy V. Ferry, Takeshi Fujisawa, Konstantin Georgiev, Dorien M. Kimenai, Kuan Ken Lee, Ziwen Li, Matthew TH. Lowry, Lynn Mckinlay, Michael Mcdermott, Jean Mcpherson, Filip Mendusic, Nicholas L. Mills, Andrew Sorbie, Grace Souter, Stacey D. Schulberg, Caelan Taggart, Christopher Tuck, Daniel Perez-Vicencio, Yiqing Wang, Ryan Wereski, Kelly Williams, Nicholas L. Mills, David E. Newby, Colin Berry, Anoop SV. Shah, Alasdair Gray, Donogh Maguire, David A. Mcallister, Richard A. Parker, Ian Ford, Nicholas L. Mills, David E. Newby, Alasdair Gray, Keith AA. Fox, Colin Berry, Paul O. Collinson, Fred S. Apple, Alan Reid, Anne Cruikshank, Iain Findlay, Shannon Amoils, David A. Mcallister, Donogh Maguire, Jennifer Stevens, John Norrie, Richard A. Parker, Christopher Weir, Anoop SV. Shah, Atul Anand, Andrew R. Chapman, Kuan Ken Lee, Nicholas L. Mills, Colin M. Fischbacher, Catriona Keerie, Bernard L. Croal, Stephen J. Leslie, Richard A. Parker, Allan Walker, Ronnie Harkess, Christopher Tuck, Tony Wackett, Christopher Weir, Roma Armstrong, Laura Stirling, Claire Macdonald, Imran Sadat, Frank Finlay, Kathy Harrison, Atul Anand, Pamela Linksted, Stephen Lavenberg

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Myocardial infarction can be ruled out in patients with a single cardiac troponin measurement. Whether use of a uniform rule-out threshold has resulted in sex-differences in care remains unclear.
Objectives: To evaluate implementation of a uniform rule-out threshold in females and males with possible myocardial infarction, and to derive and validate sex-specific thresholds.
Methods: The implementation of a uniform rule-out threshold (<5 ng/L) with a high-sensitivity cardiac troponin I assay was evaluated in consecutive patients presenting with possible myocardial infarction. The proportion of low-risk patients discharged from Emergency Department (ED) and incidence of myocardial infarction or cardiac death at 30 days were determined. Sex-specific thresholds were derived and validated, and proportion of female and male patients stratified as low-risk compared with uniform threshold.
Results: In 16,792 patients (58±17 years, 46% female) care was guided using a uniform threshold. This identified more female than male patients as low-risk (73% versus 62%), but a similar proportion of low-risk patients were discharged from ED (81% for both) with fewer than 5 (<0.1%) patients having a subsequent myocardial infarction or cardiac death at 30 days. Compared to uniform threshold of <5 ng/L, use of sex-specific thresholds would increase the proportion of female (61.8% versus 65.9%) and reduce the proportion of male (54.8% versus 47.8%) patients identified as low-risk.
Conclusions: Implementation of a uniform rule-out threshold for myocardial infarction was safe and effective in both sexes. Sex-specific rule-out thresholds should be considered, but their impact on effectiveness and safety may be limited.
Keywords: Cardiac troponin, sex, myocardial infarction
Original languageEnglish
JournalJournal of the American College of Cardiology
DOIs
Publication statusPublished - 25 Mar 2024

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