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

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 Consec...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301191/
https://www.ncbi.nlm.nih.gov/pubmed/25609052
http://dx.doi.org/10.1136/bmj.g7873
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author 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
author_facet 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
author_sort Shah, Anoop S V
collection PubMed
description 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.
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spelling pubmed-43011912015-01-28 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 BMJ Research 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. BMJ Publishing Group Ltd. 2015-01-21 /pmc/articles/PMC4301191/ /pubmed/25609052 http://dx.doi.org/10.1136/bmj.g7873 Text en © Shah et al 2015 http://creativecommons.org/licenses/by/4.0/ 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/.
spellingShingle Research
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
title High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
title_full High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
title_fullStr High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
title_full_unstemmed High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
title_short High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
title_sort high sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301191/
https://www.ncbi.nlm.nih.gov/pubmed/25609052
http://dx.doi.org/10.1136/bmj.g7873
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