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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, Vol. 1, No. 8, 01.11.2016, p. 912-920.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Rubini Giménez, M, Twerenbold, R, Boeddinghaus, J, Nestelberger, T, Puelacher, C, Hillinger, P, Wildi, K, Jaeger, C, Grimm, K, Heitzelmann, K-F, Sabti, Z, Badertscher, P, Cupa, J, Honegger, U, Schaerli, N, Kozhuharov, N, du Fay de Lavallaz, J, Lopez, B, Salgado, E, Miró, Ò, Martín-Sánchez, FJ, Adrada, ER, Morawiec, B, Parenica, J, Ganovska, E, Neugebauer, C, Rentsch, K, Lohrmann, J, Osswald, S, Reichlin, T & Mueller, C 2016, 'Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction', JAMA CARDIOL, vol. 1, no. 8, pp. 912-920. https://doi.org/10.1001/jamacardio.2016.2882

APA

Rubini Giménez, M., Twerenbold, R., Boeddinghaus, J., Nestelberger, T., Puelacher, C., Hillinger, P., Wildi, K., Jaeger, C., Grimm, K., Heitzelmann, K-F., Sabti, Z., Badertscher, P., Cupa, J., Honegger, U., Schaerli, N., Kozhuharov, N., du Fay de Lavallaz, J., Lopez, B., Salgado, E., ... Mueller, C. (2016). Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction. JAMA CARDIOL, 1(8), 912-920. https://doi.org/10.1001/jamacardio.2016.2882

Vancouver

Rubini Giménez M, Twerenbold R, Boeddinghaus J, Nestelberger T, Puelacher C, Hillinger P et al. Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction. JAMA CARDIOL. 2016 Nov 1;1(8):912-920. https://doi.org/10.1001/jamacardio.2016.2882

Bibtex

@article{04e56f22cffc4563b87414dd16512b37,
title = "Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction",
abstract = "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.",
keywords = "Aged, Biomarkers/analysis, Female, Humans, Male, Middle Aged, Myocardial Infarction/diagnosis, Prospective Studies, Sensitivity and Specificity, Troponin T/analysis",
author = "{Rubini Gim{\'e}nez}, Maria and Raphael Twerenbold and Jasper Boeddinghaus and Thomas Nestelberger and Christian Puelacher and Petra Hillinger and Karin Wildi and Cedric Jaeger and Karin Grimm and Karl-Frieder Heitzelmann and Zaid Sabti and Patrick Badertscher and Janosch Cupa and Ursina Honegger and Nicolas Schaerli and Nikola Kozhuharov and {du Fay de Lavallaz}, Jeanne and Beatriz Lopez and Emilio Salgado and {\`O}scar Mir{\'o} and Mart{\'i}n-S{\'a}nchez, {F Javier} and Adrada, {Esther Rodr{\'i}guez} and Beata Morawiec and Jiri Parenica and Eva Ganovska and Claire Neugebauer and Katharina Rentsch and Jens Lohrmann and Stefan Osswald and Tobias Reichlin and Christian Mueller",
year = "2016",
month = nov,
day = "1",
doi = "10.1001/jamacardio.2016.2882",
language = "English",
volume = "1",
pages = "912--920",
journal = "JAMA CARDIOL",
issn = "2380-6583",
publisher = "American Medical Association",
number = "8",

}

RIS

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 -