Prognostic Importance of Sex-Specific Cardiac Troponin T 99th Percentiles in Suspected Acute Coronary Syndrome - 25/07/16
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Abstract |
Objective |
Cardiac troponin levels differ between the sexes, with higher values commonly seen in men. The use of sex-specific troponin thresholds is, thus, subject of an ongoing debate. We assessed whether sex-specific cardiac troponin T (cTnT) 99th percentiles would improve risk prediction in patients admitted to Swedish coronary care units due to suspected acute coronary syndrome.
Methods |
In this retrospective register-based study (48,250 patients), we investigated the prediction of all-cause mortality and the composite of cardiovascular death or nonfatal myocardial infarction within 1 year using the single 99th cTnT percentile (>14 ng/L) or sex-specific cTnT 99th percentiles (>16/9 ng/L).
Results |
A total of 1078 men (3.0%) with cTnT 15-16 ng/L and 1854 women (8.4%) with cTnT 10-14 ng/L would have been reclassified regarding their cTnT status by the means of sex-specific 99th percentiles. The prevalence of cardiovascular risk factors and crude event rates increased across higher cTnT strata in both men and women. Multivariable-adjusted Cox models, however, did not demonstrate better risk prediction by sex-specific 99th percentiles. Assessing cTnT as a continuous variable demonstrated an increase in multivariable-adjusted risk starting at levels around 10-12 ng/L in both men and women.
Conclusions |
We found no evidence supporting the use of sex-specific cTnT 99th percentiles in men and women admitted because of suspected acute coronary syndrome. This likely depends on sex-specific differences in disease mechanisms associated with small cTnT elevations. From a pragmatic perspective, a single cTnT cutoff slightly below 14 ng/L seems to be preferable as a threshold for medical decision-making.
Le texte complet de cet article est disponible en PDF.Keywords : Acute coronary syndrome, Cardiac troponin, Cutoff, Risk prediction, Sex
Plan
Funding: The TOTAL-AMI project has received funding from the Swedish Foundation of Strategic Research. This organization had no role in the design of study, the collection and interpretation of the data, the preparation of the manuscript, and the decision to submit it for publication. |
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Conflict of Interest: KME has received honoraria from Abbott Laboratories and AstraZeneca, and has served as a consultant for Abbott Laboratories and Fiomi Diagnostics. BL has served as a consultant for Roche Diagnostics, Thermo Fisher Scientific, bioMérieux Clinical Diagnostics, Philips Healthcare, and Fiomi Diagnostics, and has received research grants from bioMérieux Clinical Diagnostics and Fiomi Diagnostics. TJ had no conflicts relevant to the content of this investigation to disclose. |
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Authorship: We verify that all authors had access to the data, participated in the planning, analysis and interpretation of the data, controlled the decision to publish and meet the criteria for authorship. |
Vol 129 - N° 8
P. 880.e1-880.e12 - août 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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