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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...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2015
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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. |
format | Online Article Text |
id | pubmed-4301191 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
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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