Journal article
Sex-specific versus overall cut points for a high sensitivity troponin I assay in predicting 1-year outcomes in emergency patients presenting with chest pain
Heart, Vol.102(2), pp.120-126
2016
PMID: 26729608
Abstract
Objective To evaluate the incidence of major adverse cardiac events (MACE) at 1 year in emergency department (ED) patients with possible acute coronary syndromes, stratified by high sensitivity troponin (hs-cTnI) concentrations using sex-specific cut points compared with overall cut points. Methods In a multicentre observational study of 2841 patients, presentation hs-cTnI concentrations were categorised using sex-specific (women 16 ng/L; men 34 ng/L) and overall (26 ng/L) cut points. The primary outcome was MACE occurring within 1 year of presentation. Patients with hs-cTnI values concentrations within these categories were reported by sex and 1-year MACE. Net reclassification improvement (NRI) was computed to measure the change in prediction after altering the hs-cTnI cut points, and was calculated separately for events and non-events. Results Application of sex-specific 99th percentile cut points rather than the overall cut point of 26 ng/L, reclassified 25 females from having a non-elevated troponin to having an elevated troponin, and 29 males from having an elevated troponin value to having a non-elevated troponin value on presentation. Of these, 7 (28.0%) females and 12 (41.4%) males had a 1-year MACE. There was no reclassification improvement for those with or without 1-year MACE (NRIevents=-1.5%, 95% CI -4.0% to 1.1%; NRInon-events -0.04%, 95% CI -0.5% to 0.4%). Conclusions Sex-specific cut points improve the identification of women but not men at risk for 1-year MACE. The net-effect across the whole ED population with possible cardiac chest pain is minimal. Lowering the clinical cut point for both sexes may be appropriate for prognostic purposes.
Details
- Title
- Sex-specific versus overall cut points for a high sensitivity troponin I assay in predicting 1-year outcomes in emergency patients presenting with chest pain
- Authors
- Louise Cullen (Author) - University of QueenslandJaimi H Greenslade (Author) - University of QueenslandEdward W Carlton (Author) - Southmead Hospital, United KingdomMartin Than (Author) - Christchurch Hospital, New ZealandJohn W Pickering (Author) - Christchurch Hospital, New ZealandAriel Ho (Author) - Royal Brisbane and Women's HospitalKim Greaves (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and EngineeringSara L Berndt (Author) - Royal Brisbane and Women's HospitalRichard Body (Author) - Central Manchester University Hospitals, United KingdomKimberley Ryan (Author) - Royal Brisbane and Women's HospitalWilliam A Parsonage (Author) - Royal Brisbane and Women's Hospital
- Publication details
- Heart, Vol.102(2), pp.120-126
- Publisher
- B M J Group
- Date published
- 2016
- DOI
- 10.1136/heartjnl-2015-308506
- ISSN
- 1355-6037
- PMID
- 26729608
- Organisation Unit
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99449482102621
- Output Type
- Journal article
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- Cardiac & Cardiovascular Systems
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