title: Gender-specific diagnostic performance of a new high-sensitivity cardiac troponin I assay for detection of acute myocardial infarction.
abstract: BACKGROUND
  The determination of cardiac troponin is essential for diagnosing myocardial infarction. A troponin I assay has recently been developed that provides the highest analytical sensitivity to date.
  
  
  METHODS
  The analysis included 1560 patients with chest pain, of whom 1098 were diagnosed with non-coronary chest pain, 189 with unstable angina pectoris and 273 with non-ST-segment elevation myocardial infarction. The troponin I concentration was determined on admission (0 hours) and 3 hours later. The diagnostic algorithm incorporated troponin I elevation above the gender-specific 99th percentile as well as predefined relative or absolute 3-hour changes in the troponin I concentration (delta).
  
  
  RESULTS
  The diagnostic criterion of troponin I above the 99th percentile resulted in a negative predictive value of 98.0% and 98.2% in men and women, respectively. For rule-in of non-ST-segment elevation myocardial infarction, the use of absolute deltas yielded higher positive predictive values and sensitivities compared to relative deltas. With detection rates of about 85% and 82% in men and women, respectively, non-ST-segment elevation myocardial infarction was diagnosed with a positive predictive value close to 84% in men and 80% in women.
  
  
  CONCLUSIONS
  The investigational troponin I assay provides an excellent non-ST-segment elevation myocardial infarction rule out. With gender-specific differences, the application of absolute changes in troponin concentration was superior to relative changes to rule in patients with non-ST-segment elevation myocardial infarction.
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Schofer
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Fabian J
authors.initials: FJ
authors.lastname: Brunner
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schlüter
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: 2 Herzzentrum der Universität zu Köln, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: 3 Department of Internal Medicine, Federal Armed Forces Hospital Koblenz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.affiliation: 4 Department of Laboratory Medicine, Johannes Gutenberg University, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: 5 Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: 5 Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany.|6 3rd Department of Cardiology, Aristotle University of Thessaloniki, Greece.
authors.forename: Stergios
authors.initials: S
authors.lastname: Tzikas
authors.affiliation: 7 Department of Internal Medicine I, Katholisches Klinikum Mainz, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Genth-Zotz
authors.affiliation: 8 Cardiology Practice Griesheim, Germany.
authors.forename: Ascan
authors.initials: A
authors.lastname: Warnholtz
authors.affiliation: 5 Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany.|7 Department of Internal Medicine I, Katholisches Klinikum Mainz, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Post
authors.affiliation: 9 Department of Cardiology, Johann Wolfgang Goethe University Hospital, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.|10 Department of Cardiology, Asklepios Klinik Harburg, Germany.
authors.forename: Britta U
authors.initials: BU
authors.lastname: Goldmann
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000378:metabolism; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012727:Sex Characteristics; D019210:Troponin I / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Non-ST-segment elevation myocardial infarction; acute myocardial infarction; cardiac troponin; diagnostic performance; gender-specific; high-sensitivity