Impact of high-sensitivity troponin I testing with sex-specific cutoffs on the diagnosis of acute myocardial infarction

Christina Trambas, John W Pickering, Martin Than, Chris Bain, Lucy Nie, Eldho Paul, Anthony Dart, Arch Broughton, Hans Gerhard Schneider

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) assays show sex-dependent differences in the 99th percentile of healthy populations, with concentrations in women approximately 50% lower. The adoption of sex-specific cutoffs seems appropriate, although it is not yet clear what effect these will have on acute myocardial infarction (AMI) diagnosis and management. 

METHODS: We conducted a retrospective pre- and postchangeover analysis of troponin I testing in the 6 months before and after moving from the contemporary Abbott Architect TnI assay (cTnI) to hs-cTnI at 2 tertiary centers in Australia and New Zealand. The cTnI cutoff was 30 ng/L for both sexes, whereas a female-specific cutoff of 16 ng/L was adopted upon changeover to hsTnI. 

RESULTS: Changeover from the cTnI assay to the hs-cTnI assay increased the number of female patients with increased troponin I concentrations at both sites (from 29.7% to 34.9% and from 22.4% to 30.8%; P < 0.001). There was no statistically significant change in the number of men with increased concentrations in the same time period (P = 0.09). The increased percentage of women with increased troponin I was not associated with an increase in the number of women with AMI diagnoses at either center. Angiographic data available from 1 center showed no change in the percentage of angiograms performed in women. 

CONCLUSIONS: Although increasing the proportion of women with increased troponin I, adopting sex-specific cutoffs with the hs-cTnI assay did not lead to an increase in AMI diagnoses in females, or in the number of women undergoing angiography.

Original languageEnglish
Pages (from-to)831-838
Number of pages8
JournalClinical Chemistry
Volume62
Issue number6
DOIs
Publication statusPublished - 1 Jun 2016

Cite this

Trambas, Christina ; Pickering, John W ; Than, Martin ; Bain, Chris ; Nie, Lucy ; Paul, Eldho ; Dart, Anthony ; Broughton, Arch ; Schneider, Hans Gerhard. / Impact of high-sensitivity troponin I testing with sex-specific cutoffs on the diagnosis of acute myocardial infarction. In: Clinical Chemistry. 2016 ; Vol. 62, No. 6. pp. 831-838.
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title = "Impact of high-sensitivity troponin I testing with sex-specific cutoffs on the diagnosis of acute myocardial infarction",
abstract = "BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) assays show sex-dependent differences in the 99th percentile of healthy populations, with concentrations in women approximately 50{\%} lower. The adoption of sex-specific cutoffs seems appropriate, although it is not yet clear what effect these will have on acute myocardial infarction (AMI) diagnosis and management. METHODS: We conducted a retrospective pre- and postchangeover analysis of troponin I testing in the 6 months before and after moving from the contemporary Abbott Architect TnI assay (cTnI) to hs-cTnI at 2 tertiary centers in Australia and New Zealand. The cTnI cutoff was 30 ng/L for both sexes, whereas a female-specific cutoff of 16 ng/L was adopted upon changeover to hsTnI. RESULTS: Changeover from the cTnI assay to the hs-cTnI assay increased the number of female patients with increased troponin I concentrations at both sites (from 29.7{\%} to 34.9{\%} and from 22.4{\%} to 30.8{\%}; P < 0.001). There was no statistically significant change in the number of men with increased concentrations in the same time period (P = 0.09). The increased percentage of women with increased troponin I was not associated with an increase in the number of women with AMI diagnoses at either center. Angiographic data available from 1 center showed no change in the percentage of angiograms performed in women. CONCLUSIONS: Although increasing the proportion of women with increased troponin I, adopting sex-specific cutoffs with the hs-cTnI assay did not lead to an increase in AMI diagnoses in females, or in the number of women undergoing angiography.",
author = "Christina Trambas and Pickering, {John W} and Martin Than and Chris Bain and Lucy Nie and Eldho Paul and Anthony Dart and Arch Broughton and Schneider, {Hans Gerhard}",
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Impact of high-sensitivity troponin I testing with sex-specific cutoffs on the diagnosis of acute myocardial infarction. / Trambas, Christina; Pickering, John W; Than, Martin; Bain, Chris; Nie, Lucy; Paul, Eldho; Dart, Anthony; Broughton, Arch; Schneider, Hans Gerhard.

In: Clinical Chemistry, Vol. 62, No. 6, 01.06.2016, p. 831-838.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Impact of high-sensitivity troponin I testing with sex-specific cutoffs on the diagnosis of acute myocardial infarction

AU - Trambas, Christina

AU - Pickering, John W

AU - Than, Martin

AU - Bain, Chris

AU - Nie, Lucy

AU - Paul, Eldho

AU - Dart, Anthony

AU - Broughton, Arch

AU - Schneider, Hans Gerhard

PY - 2016/6/1

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N2 - BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) assays show sex-dependent differences in the 99th percentile of healthy populations, with concentrations in women approximately 50% lower. The adoption of sex-specific cutoffs seems appropriate, although it is not yet clear what effect these will have on acute myocardial infarction (AMI) diagnosis and management. METHODS: We conducted a retrospective pre- and postchangeover analysis of troponin I testing in the 6 months before and after moving from the contemporary Abbott Architect TnI assay (cTnI) to hs-cTnI at 2 tertiary centers in Australia and New Zealand. The cTnI cutoff was 30 ng/L for both sexes, whereas a female-specific cutoff of 16 ng/L was adopted upon changeover to hsTnI. RESULTS: Changeover from the cTnI assay to the hs-cTnI assay increased the number of female patients with increased troponin I concentrations at both sites (from 29.7% to 34.9% and from 22.4% to 30.8%; P < 0.001). There was no statistically significant change in the number of men with increased concentrations in the same time period (P = 0.09). The increased percentage of women with increased troponin I was not associated with an increase in the number of women with AMI diagnoses at either center. Angiographic data available from 1 center showed no change in the percentage of angiograms performed in women. CONCLUSIONS: Although increasing the proportion of women with increased troponin I, adopting sex-specific cutoffs with the hs-cTnI assay did not lead to an increase in AMI diagnoses in females, or in the number of women undergoing angiography.

AB - BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) assays show sex-dependent differences in the 99th percentile of healthy populations, with concentrations in women approximately 50% lower. The adoption of sex-specific cutoffs seems appropriate, although it is not yet clear what effect these will have on acute myocardial infarction (AMI) diagnosis and management. METHODS: We conducted a retrospective pre- and postchangeover analysis of troponin I testing in the 6 months before and after moving from the contemporary Abbott Architect TnI assay (cTnI) to hs-cTnI at 2 tertiary centers in Australia and New Zealand. The cTnI cutoff was 30 ng/L for both sexes, whereas a female-specific cutoff of 16 ng/L was adopted upon changeover to hsTnI. RESULTS: Changeover from the cTnI assay to the hs-cTnI assay increased the number of female patients with increased troponin I concentrations at both sites (from 29.7% to 34.9% and from 22.4% to 30.8%; P < 0.001). There was no statistically significant change in the number of men with increased concentrations in the same time period (P = 0.09). The increased percentage of women with increased troponin I was not associated with an increase in the number of women with AMI diagnoses at either center. Angiographic data available from 1 center showed no change in the percentage of angiograms performed in women. CONCLUSIONS: Although increasing the proportion of women with increased troponin I, adopting sex-specific cutoffs with the hs-cTnI assay did not lead to an increase in AMI diagnoses in females, or in the number of women undergoing angiography.

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DO - 10.1373/clinchem.2015.252569

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