title: Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T - Sub-analysis from the TRAPID-AMI study.
abstract: OBJECTIVE
  To evaluate the impact of age- and gender-specific cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) compared to the general 99th percentile hs-cTnT cut-off on diagnosis and prognosis of acute myocardial infarction (AMI).
  
  
  METHODS
  1282 unselected patients presenting to the emergency department with suspected AMI were enrolled as part of the TRAPID-AMI study. In the present sub-analysis, reclassification of AMI diagnosis was performed by comparing the general hs-cTnT cut-off of 14ng/L to previously proposed age- and gender-dependent hs-cTnT 99th percentile cut-offs (28ng/L for ≥65years, 9ng/L for female and 15.5ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS.
  
  
  RESULTS
  For patients ≥65years, application of age-specified cut-offs resulted in a decrease of AMI from 29.8% to 18.3% in the entire cohort (n=557) and 54.7% to 40.9% in the ACS subcohort (n=225). Using gender-specific cut-offs, AMI-rate increased from 16.6% to 22.6% (entire cohort, n=477) and 62.6% to 71.7% (ACS subcohort, n=99) in women, whereas in men, rates decreased from 23.1% to 21.1% (entire cohort, n=805) and 48.8% to 45.9% (ACS, n=281), respectively. Age-specified cut-offs significantly reclassified patients for outcomes of 1-month and 3-month mortality in the entire and ACS cohort (14.2% net reclassification improvement, p<0.001, respectively). Contrary, no significant differences in outcomes could be found using gender-specific cut-offs.
  
  
  CONCLUSIONS
  While influence of gender-specific hs-cTnT cut-offs on diagnostic and prognostic reclassification was only modest in patients with suspected AMI, age-specific cut-offs showed a significant impact and may be considered for further validation.
authors.affiliation: Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Mueller-Hennessen
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: evangelos_giannitsis@med.uni-heidelberg.de.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Biener
authors.affiliation: Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Mehrshad
authors.initials: M
authors.lastname: Vafaie
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: deFilippi
authors.affiliation: Department of Emergency and Critical Care Medicine, Community Hospital, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.affiliation: Semicritical Unit, Hospital de Sant Pau &, Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Santalo-Bel
authors.affiliation: Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Panteghini
authors.affiliation: Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.affiliation: Department of Acute Medicine, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.affiliation: Department of Medicine, KarolinskaInstitutet, Huddinge, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Liverpool Hospital, University of New South Wales, Sydney, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Body
authors.affiliation: Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, United States.
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.affiliation: Roche Diagnostics Germany, Penzberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Dilba
authors.affiliation: Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012737:Sex Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: AMI; Age; Diagnosis; Gender; High-sensitivity cardiac Troponin T, 99th percentile; Prognosis