Differential expression of cardiac biomarkers by gender in patients with unstable angina/non-ST-elevation myocardial infarction: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) substudy.
BACKGROUND
Diagnosis of coronary artery disease in women is more difficult because of lower specificity of symptoms and diagnostic accuracy of noninvasive testing. We sought to examine the relationship between gender and cardiac biomarkers in patients with unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI).


RESULTS
In the TACTICS-TIMI 18, OPUS-TIMI 16, and TIMI 11 studies, baseline samples were analyzed in the Thrombolysis In Myocardial Infarction (TIMI) biomarker core laboratory. We examined the relationship between gender and elevated biomarkers. Of 1865 patients from TACTICS-TIMI 18, 34% were women. Fewer women had elevated creatine kinase-MB or troponins, whereas more had elevated high-sensitivity C-reactive protein or brain natriuretic peptide. Presence of ST-segment deviation and TIMI risk scores were not significantly different. This pattern was confirmed in TIMI 11 and OPUS-TIMI 16. The prognostic value of the markers in TACTICS-TIMI 18 was similar in women and men. When a multimarker approach was examined, a greater proportion of high-risk women were identified. Marker-positive patients of both genders had improved outcome with an invasive strategy; however, marker-negative women appeared to have improved outcomes with a conservative strategy.


CONCLUSIONS
In patients with UA/NSTEMI, there was a different pattern of presenting biomarkers. Men were more likely to have elevated creatine kinase-MB and troponins, whereas women were more likely to have elevated C-reactive protein and brain natriuretic peptide. This suggests that a multimarker approach may aid the initial risk assessment of UA/NSTEMI, especially in women. Further research is necessary to elucidate whether gender-related pathophysiological differences exist in presentation with acute coronary syndromes.
Wiviott
Stephen D
SD
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115, USA. swiviott@partners.org
Cannon
Christopher P
CP
Morrow
David A
DA
Murphy
Sabina A
SA
Gibson
C Michael
CM
McCabe
Carolyn H
CH
Sabatine
Marc S
MS
Rifai
Nader
N
Giugliano
Robert P
RP
DiBattiste
Peter M
PM
Demopoulos
Laura A
LA
Antman
Elliott M
EM
Braunwald
Eugene
E
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003131:Combined Modality Therapy; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D009206:Myocardium / Q000378:metabolism; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012737:Sex Factors; D013577:Syndrome; D015912:Thrombolytic Therapy; D000077466:Tirofiban; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D015415:Biomarkers; D005343:Fibrinolytic Agents; D007527:Isoenzymes; D014336:Troponin; D020097:Natriuretic Peptide, Brain; D014443:Tyrosine; D002097:C-Reactive Protein; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D000077466:Tirofiban