Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome

被引：98

作者：

Lee, Kuan Ken ^{[1
]}

Ferry, Amy V. ^{[1
]}

Anand, Atul ^{[1
]}

Strachan, Fiona E. ^{[1
]}

Chapman, Andrew R. ^{[1
]}

Kimenai, Dorien M. ^{[2
,3
]}

Meex, Steven J. R. ^{[2
,3
]}

Berry, Colin ^{[4
]}

Findlay, Iain ^{[5
]}

Reid, Alan ^{[6
]}

Cruickshank, Anne ^{[6
]}

Gray, Alasdair ^{[7
]}

Collinson, Paul O. ^{[8
,9
,10
]}

Apple, Fred S. ^{[11
,12
]}

McAllister, David A. ^{[13
]}

Maguire, Donogh ^{[14
]}

Fox, Keith A. A. ^{[1
]}

Newby, David E. ^{[1
]}

Tuck, Chris ^{[15
]}

Keerie, Catriona ^{[15
]}

Weir, Christopher J. ^{[15
]}

Shah, Anoop S. V. ^{[1
,16
]}

Mills, Nicholas L. ^{[1
,16
]}

机构：

[1] Univ Edinburgh, Ctr Cardiovasc Sci, British Heart Fdn, Edinburgh, Midlothian, Scotland

[2] Maastricht Univ, CARIM Sch Cardiovasc Dis, Maastricht, Netherlands

[3] Maastricht Univ, Med Ctr, Cent Diagnost Lab, Maastricht, Netherlands

[4] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[5] Royal Alexandra Hosp, Dept Cardiol, Paisley, Renfrew, Scotland

[6] Queen Elizabeth Univ Hosp, Dept Biochem, Glasgow, Lanark, Scotland

[7] Royal Infirm Edinburgh NHS Trust, Emergency Med Res Grp Edinburgh, Edinburgh, Midlothian, Scotland

[8] St Georges Univ Hosp NHS Trust, Dept Clin Blood Sci, London, England

[9] St Georges Univ Hosp NHS Trust, Dept Cardiol, London, England

[10] St Georges Univ London, London, England

[11] Hennepin Cty Med Ctr, Dept Lab Med & Pathol, Minneapolis, MN 55415 USA

[12] Univ Minnesota, Minneapolis, MN USA

[13] Univ Glasgow, Inst Hlth & Wellbeing, Glasgow, Lanark, Scotland

[14] Glasgow Royal Infirm, Emergency Med Dept, Glasgow, Lanark, Scotland

[15] Univ Edinburgh, Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland

[16] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2019年 / 74卷 / 16期

关键词：

acute coronary syndrome; high-sensitivity cardiac troponin; myocardial infarction; sex-specific threshold; CARDIAC TROPONIN; MYOCARDIAL-INFARCTION; I ASSAY; WOMEN; METAANALYSIS; DIAGNOSIS; CUTOFFS; RISK;

D O I：

10.1016/j.jacc.2019.07.082

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Major disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized. OBJECTIVES The aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome. METHODS Consecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury was defined as high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/l in women and 34 ng/l in men. The primary outcome was recurrent myocardial infarction or cardiovascular death at 1 year. RESULTS A total of 48,282 patients (47% women) were included. Use of the high-sensitivity cardiac troponin I assay with sex-specific thresholds increased myocardial injury in women by 42% and in men by 6%. Following implementation, women with myocardial injury remained less likely than men to undergo coronary revascularization (15% vs. 34%) and to receive dual antiplatelet (26% vs. 43%), statin (16% vs. 26%), or other preventive therapies (p < 0.001 for all). The primary outcome occurred in 18% (369 of 2,072) and 17% (488 of 2,919) of women with myocardial injury before and after implementation, respectively (adjusted hazard ratio: 1.11; 95% confidence interval: 0.92 to 1.33), compared with 18% (370 of 2,044) and 15% (513 of 3,325) of men (adjusted hazard ratio: 0.85; 95% confidence interval: 0.71 to 1.01). CONCLUSIONS Use of sex-specific thresholds identified 5 times more additional women than men with myocardial injury. Despite this increase, women received approximately one-half the number of treatments for coronary artery disease as men, and outcomes were not improved. (C) 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.

引用

页码：2032 / 2043

页数：12

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