Abstract 12375: Gender-Related Differences in the Prognostic Value of Biomarkers in Patients With Acute Chest Pain Without Myocardial Infarction

Abstract

Introduction: Patients presenting with acute chest pain may carry an increased risk of cardiovascular events even though myocardial infarction (MI) is excluded. Whether there are gender-related differences in the prognostic value of biomarkers in this patient population is unclear. Methods: We performed a post hoc analysis of the WESTCOR trial that included 1319 patients (779 male and 540 female) admitted with acute chest pain without MI. Biomarkers included peak high sensitivity cardiac troponin T (hs-cTnT), peak high sensitivity cardiac troponin I (hs-cTnI), N-terminal proB-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15) and C-reactive protein (CRP), all from Roche Diagnostics. Cox regression analysis was performed for ln-transformed biomarkers in unadjusted models and models adjusting for age, hypercholesterolemia, current smoking, diabetes, hypertension, previous MI and eGFR <60 ml/min/1.73m2 in predicting a combined endpoint of all-cause mortality, future MI and hospitalization for acute heart failure. Gender differences in C-statistics were also estimated. Results: During a median follow-up of 1545 days (range 4 - 2208), the endpoint occurred in 11% of females and 13% of males (p = 0.212). Peak biomarker levels are shown in Table 1a. In the unadjusted and adjusted Cox regression analysis, increasing levels of all biomarkers were associated with a higher risk of death and cardiovascular events in women, but the interaction by gender was only significant for NT-proBNP and GDF-15 ( Table 1b ). The C-statistic for prediction of the endpoint was significantly higher for hs-cTnI and GDF-15 in women than in men ( Table 1c ). For hs-cTnT, NT-proBNP and CRP the difference in C-statistic between genders was non-significant. Conclusion: Circulating concentrations of cardiac troponins, GDF-15 and NT-proBNP seem to be associated with a higher risk of death and cardiovascular events in women compared to men.