Lee, K. K. et al. (2019) Sex-specific thresholds of high-sensitivity troponin in patients with suspected acute coronary syndrome. Journal of the American College of Cardiology, 74(16), pp. 2032-2043. (doi: 10.1016/j.jacc.2019.07.082) (PMID:31623760) (PMCID:PMC6876271)
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Abstract
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. (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]; NCT01852123).
| Item Type: | Articles |
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| Additional Information: | This trial was funded by a Special Project Grant from the British Heart Foundation (BHF) (SP/12/10/29922) with additional support from a BHF-Turing Cardiovascular Data Science Award (BCDSA/100003) and BHF Research Excellence Award (RE/18/5/34216). KKL, ASVS and NLM are supported by a Clinical Research Training Fellowship (FS/18/25/33454), an Intermediate Clinical Research Fellowship (FS/19/17/34172) and the Butler Senior Clinical Research Fellowship (FS/16/14/32023), from the British Heart Foundation. CJW was supported by NHS Lothian through the Edinburgh Clinical Trials Unit. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McAllister, Professor David and Cruickshank, Dr Anne and Berry, Professor Colin and Maguire, Donogh |
| Authors: | Lee, K. K., Ferry, A. V., Anand, A., Strachan, F. E., Chapman, A. R., Kimenai, D. M., Meex, S. J.R., Berry, C., Findlay, I., Reid, A., Cruickshank, A., Gray, A., Collinson, P. O., Apple, F. S., McAllister, D. A., Maguire, D., Fox, K. A.A., Newby, D. E., Tuck, C., Keerie, C., Weir, C. J., Shah, A. S.V., and Mills, N. L. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Journal of the American College of Cardiology |
| Publisher: | Elsevier |
| ISSN: | 0735-1097 |
| ISSN (Online): | 1558-3597 |
| Published Online: | 14 October 2019 |
| Copyright Holders: | Copyright © 2019 The Authors |
| First Published: | First published in Journal of the American College of Cardiology 74(16): 2032-2043 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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