Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction
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Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction. / Rubini Giménez, Maria; Twerenbold, Raphael; Boeddinghaus, Jasper; Nestelberger, Thomas; Puelacher, Christian; Hillinger, Petra; Wildi, Karin; Jaeger, Cedric; Grimm, Karin; Heitzelmann, Karl-Frieder; Sabti, Zaid; Badertscher, Patrick; Cupa, Janosch; Honegger, Ursina; Schaerli, Nicolas; Kozhuharov, Nikola; du Fay de Lavallaz, Jeanne; Lopez, Beatriz; Salgado, Emilio; Miró, Òscar; Martín-Sánchez, F Javier; Adrada, Esther Rodríguez; Morawiec, Beata; Parenica, Jiri; Ganovska, Eva; Neugebauer, Claire; Rentsch, Katharina; Lohrmann, Jens; Osswald, Stefan; Reichlin, Tobias; Mueller, Christian.
in: JAMA CARDIOL, Jahrgang 1, Nr. 8, 01.11.2016, S. 912-920.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction
AU - Rubini Giménez, Maria
AU - Twerenbold, Raphael
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Puelacher, Christian
AU - Hillinger, Petra
AU - Wildi, Karin
AU - Jaeger, Cedric
AU - Grimm, Karin
AU - Heitzelmann, Karl-Frieder
AU - Sabti, Zaid
AU - Badertscher, Patrick
AU - Cupa, Janosch
AU - Honegger, Ursina
AU - Schaerli, Nicolas
AU - Kozhuharov, Nikola
AU - du Fay de Lavallaz, Jeanne
AU - Lopez, Beatriz
AU - Salgado, Emilio
AU - Miró, Òscar
AU - Martín-Sánchez, F Javier
AU - Adrada, Esther Rodríguez
AU - Morawiec, Beata
AU - Parenica, Jiri
AU - Ganovska, Eva
AU - Neugebauer, Claire
AU - Rentsch, Katharina
AU - Lohrmann, Jens
AU - Osswald, Stefan
AU - Reichlin, Tobias
AU - Mueller, Christian
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Importance: It is currently unknown whether the uniform (universal clinical practice for more than 2 decades) or 2 sex-specific cutoff levels are preferable when using high-sensitivity cardiac troponin T (hs-cTnT) levels in the diagnosis of acute myocardial infarction (AMI).Objective: To improve the management of suspected AMI in women by exploring sex-specific vs uniform cutoff levels for hs-cTnT.Design, Setting, and Participants: In an ongoing prospective, diagnostic, multicenter study conducted at 9 emergency departments, the present study evaluated patients enrolled from April 21, 2006, through June 5, 2013. The participants included 2734 adults presenting with suspected AMI. Duration of follow-up was 2 years, and data analysis occurred from June 5 to December 21, 2015.Interventions: The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including measurements of serial hs-cTnT blood concentrations twice: once using the uniform 99th percentile cutoff value level of 14 ng/L and once using sex-specific 99th percentile levels of hs-cTnT (women, 9 ng/L; men, 15.5 ng/L).Main Outcomes and Measures: Diagnostic reclassification in women and men using sex-specific vs the uniform cutoff level in the diagnosis of AMI.Results: Of the 2734 participants, 876 women (32%) and 1858 men (68%) were included. Median (interquartile range) age was 68 (55-77) and 59 (48-71) years, respectively. With the use of the uniform cutoff value, 127 women (14.5%) and 345 men (18.6%) received a final diagnosis of AMI. Among these, at emergency department presentation, levels of hs-cTnT were already above the uniform cutoff value in 427 patients (sensitivity, 91.3% [95% CI, 85%-95.6%] in women vs 90.7% [95% CI, 87.1%-93.5% in men]; specificity, 79.2% [95% CI, 76.1%-82.1%] in women vs 78.5% [95% CI, 76.4%-80.6%] in men). After readjudication using sex-specific 99th percentile levels, diagnostic reclassification regarding AMI occurred in only 3 patients: 0.11% (95% CI, 0.02-0.32) of all patients and 0.6% (95% CI, 0.13-1.85) of patients with AMI. The diagnosis in 2 women was upgraded from unstable angina to AMI, and the diagnosis in 1 man was downgraded from AMI to unstable angina. These diagnostic results were confirmed when using 2 alternative pairs of uniform and sex-specific cutoff values.Conclusions and Relevance: The uniform 99th percentile should remain the standard of care when using hs-cTnT levels for the diagnosis of AMI.
AB - Importance: It is currently unknown whether the uniform (universal clinical practice for more than 2 decades) or 2 sex-specific cutoff levels are preferable when using high-sensitivity cardiac troponin T (hs-cTnT) levels in the diagnosis of acute myocardial infarction (AMI).Objective: To improve the management of suspected AMI in women by exploring sex-specific vs uniform cutoff levels for hs-cTnT.Design, Setting, and Participants: In an ongoing prospective, diagnostic, multicenter study conducted at 9 emergency departments, the present study evaluated patients enrolled from April 21, 2006, through June 5, 2013. The participants included 2734 adults presenting with suspected AMI. Duration of follow-up was 2 years, and data analysis occurred from June 5 to December 21, 2015.Interventions: The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including measurements of serial hs-cTnT blood concentrations twice: once using the uniform 99th percentile cutoff value level of 14 ng/L and once using sex-specific 99th percentile levels of hs-cTnT (women, 9 ng/L; men, 15.5 ng/L).Main Outcomes and Measures: Diagnostic reclassification in women and men using sex-specific vs the uniform cutoff level in the diagnosis of AMI.Results: Of the 2734 participants, 876 women (32%) and 1858 men (68%) were included. Median (interquartile range) age was 68 (55-77) and 59 (48-71) years, respectively. With the use of the uniform cutoff value, 127 women (14.5%) and 345 men (18.6%) received a final diagnosis of AMI. Among these, at emergency department presentation, levels of hs-cTnT were already above the uniform cutoff value in 427 patients (sensitivity, 91.3% [95% CI, 85%-95.6%] in women vs 90.7% [95% CI, 87.1%-93.5% in men]; specificity, 79.2% [95% CI, 76.1%-82.1%] in women vs 78.5% [95% CI, 76.4%-80.6%] in men). After readjudication using sex-specific 99th percentile levels, diagnostic reclassification regarding AMI occurred in only 3 patients: 0.11% (95% CI, 0.02-0.32) of all patients and 0.6% (95% CI, 0.13-1.85) of patients with AMI. The diagnosis in 2 women was upgraded from unstable angina to AMI, and the diagnosis in 1 man was downgraded from AMI to unstable angina. These diagnostic results were confirmed when using 2 alternative pairs of uniform and sex-specific cutoff values.Conclusions and Relevance: The uniform 99th percentile should remain the standard of care when using hs-cTnT levels for the diagnosis of AMI.
KW - Aged
KW - Biomarkers/analysis
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Prospective Studies
KW - Sensitivity and Specificity
KW - Troponin T/analysis
U2 - 10.1001/jamacardio.2016.2882
DO - 10.1001/jamacardio.2016.2882
M3 - SCORING: Journal article
C2 - 27653005
VL - 1
SP - 912
EP - 920
JO - JAMA CARDIOL
JF - JAMA CARDIOL
SN - 2380-6583
IS - 8
ER -