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

Shah, A. S.V. et al. (2015) High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. British Medical Journal, 2015(350), g7873. (doi: 10.1136/bmj.g7873) (PMID:25609052) (PMCID:PMC4301191)

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Abstract

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Professor David and Newby, Professor David
Authors: Shah, A. S.V., Griffiths, M., Lee, K. K., McAllister, D. A., Hunter, A. L., Ferry, A. V., Cruikshank, A., Reid, A., Stoddart, M., Strachan, F., Walker, S., Collinson, P. O., Apple, F. S., Gray, A. J., Fox, K. A.A., Newby, D. E., and Mills, N. L.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:British Medical Journal
Publisher:BMJ Publishing Group
ISSN:0959-8138
ISSN (Online):1756-1833
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in British Medical Journal 2015(350): g7873
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
620161High-Sensitive Troponin in the evaluation of patients with Acute Coronary Syndrome (HighSTEACS): A randomised control trialColin BerryBritish Heart Foundation (BHF)SP/12/10/29922RI CARDIOVASCULAR & MEDICAL SCIENCES