title: Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction.
abstract: 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).
  
  
  
  To improve the management of suspected AMI in women by exploring sex-specific vs uniform cutoff levels for hs-cTnT.
  
  
  
  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.
  
  
  
  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).
  
  
  
  Diagnostic reclassification in women and men using sex-specific vs the uniform cutoff level in the diagnosis of AMI.
  
  
  
  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.
  
  
  
  The uniform 99th percentile should remain the standard of care when using hs-cTnT levels for the diagnosis of AMI.
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network3Emergency Department, Centro de Investigación Biomédica en Red Enfermedades Respiratorias Instituto de Salud Carlos III, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Giménez
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Jasper
authors.initials: J
authors.lastname: Boeddinghaus
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nestelberger
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Christian
authors.initials: C
authors.lastname: Puelacher
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Hillinger
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Cedric
authors.initials: C
authors.lastname: Jaeger
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Karin
authors.initials: K
authors.lastname: Grimm
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Karl-Frieder
authors.initials: KF
authors.lastname: Heitzelmann
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Sabti
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Badertscher
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Janosch
authors.initials: J
authors.lastname: Cupa
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Ursina
authors.initials: U
authors.lastname: Honegger
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Schaerli
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Kozhuharov
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Jeanne
authors.initials: J
authors.lastname: du Fay de Lavallaz
authors.affiliation: Global Research in Acute Conditions Network4Emergency Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lopez
authors.affiliation: Global Research in Acute Conditions Network4Emergency Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Salgado
authors.affiliation: Global Research in Acute Conditions Network4Emergency Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Emergency Department, Hospital Clinic San Carlos, Madrid, Spain.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.affiliation: Emergency Department, Hospital Clinic San Carlos, Madrid, Spain.
authors.forename: Esther Rodríguez
authors.initials: ER
authors.lastname: Adrada
authors.affiliation: Second Cardiology Department, Zabrze, University of Silesia, Katowice, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Morawiec
authors.affiliation: Department of Cardiology, University Hospital, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.affiliation: Department of Cardiology, University Hospital, Brno, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Ganovska
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Claire
authors.initials: C
authors.lastname: Neugebauer
authors.affiliation: Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Lohrmann
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland2Global Research in Acute Conditions Network.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000032:analysis*
chemical_list: D015415:Biomarkers; D020107:Troponin T