title: Sex differences of troponin test performance in chest pain patients.
abstract: BACKGROUND
  Current guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse.
  
  
  OBJECTIVE
  To evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex.
  
  
  METHODS
  Between 15th of February 2009 and 15th of February 2010, women (n=1648) and men (n=2305) who presented to the emergency department with chest pain (n=3954) were enrolled. The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI; Stratus® CS, Siemens and TnT; Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed.
  
  
  RESULTS
  NSTEMI was diagnosed in 7.3% (n=287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8%; n=202) as compared to women (5.2%; n=85; p<0.001). Sensitivity was 56.1% (95% CI: 44.7-67.0%) in women and 70.1% (95% CI: 63.1-76.4%) in men. Specificity was 96.8% (95% CI: 95.6-97.7%) in women and 94.5% (95% CI: 93.3-95.6%) in men. This resulted in a lower positive predictive value (PPV) for women (53.5%; 95% CI: 42.4-64.3) as compared to men (60.8%; 95% CI: 54.1-67.2) and a slightly higher negative predictive value (NPV) for women: 97.1% (95% CI: 96.0-97.9) vs. 96.3% (95% CI: 95.2-97.2) in men.
  
  
  CONCLUSIONS
  The findings of this study underline that the performance of cTn for the diagnosis of NSTEMI depends on a patient's sex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable.
authors.affiliation: Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité University Hospital, Berlin, Germany. Electronic address: anna.slagman@charite.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.affiliation: Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité University Hospital, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.affiliation: Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité University Hospital, Berlin, Germany; Thermofisher Scientific, Hennigsdorf, Germany.
authors.forename: Jörn O
authors.initials: JO
authors.lastname: Vollert
authors.affiliation: Department for Information Technics, Division of Clinical Procedures, Charité University Hospital, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Storchmann
authors.affiliation: Department of Laboratory Medicine CVK, Charité University Hospital, Berlin, Germany.
authors.forename: Dirk Meyer Zum
authors.initials: DM
authors.lastname: Büschenfelde
authors.affiliation: Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité University Hospital, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: von Recum
authors.affiliation: Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité University Hospital, Berlin, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Vlasny
authors.affiliation: Department of Emergency Medicine CBF, Charité University Hospital, Berlin, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Ale-Abaei
authors.affiliation: Department of Emergency Medicine CBF, Charité University Hospital, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Koch
authors.affiliation: Department of Laboratory Medicine CVK, Charité University Hospital, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Australia.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Müller
authors.affiliation: Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Australia.
authors.forename: Rajan
authors.initials: R
authors.lastname: Somasundaram
authors.affiliation: Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité University Hospital, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012737:Sex Factors; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin
keywords: Acute myocardial infarction; Chest pain diagnosis; Gender; Sex; Troponin