Abstract
Using high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific 99th percentiles may improve management of patients with suspected acute myocardial infarction (AMI). We investigated the impact of transitioning from a conventional troponin I assay to a high-sensitivity assay with sex-specific thresholds, in patients with suspected acute coronary syndrome admitted to Swedish coronary care units. Based on data from SWEDEHEART registry (females, n = 4,819/males, n = 7,670), we compared periods before and after implementation of hs-cTnI assay (Abbott) using sex-specific 99th percentiles. We investigated differences on discharge diagnosis, in-hospital examinations, treatments, and clinical outcome. Upon implementation of the hs-cTnI assay, proportion of patients with troponin levels above diagnostic AMI threshold increased in women and men by 24.3% versus 14.8%, respectively. Similarly, incidence of AMI increased by 11.5% and 9.8%. Diagnostic interventions and treatments increased regardless of sex. However, these associations did not persist following multivariable adjustment, probably due to the effect of temporal management trends during the observation period. Overall, no risk reduction on major adverse cardiovascular events was observed (HR: 0.91 [95% CI 0.80–1.03], P = 0.126). The implementation of hs-cTnI assay together with sex-specific 99th percentiles was associated with an increase in incidence of AMI regardless of sex, but had no major impact on clinical management and prognosis.
Highlights
Using high-sensitivity cardiac troponin assays with sex-specific 99th percentiles may improve management of patients with suspected acute myocardial infarction (AMI)
A total of 15,313 patients were admitted during respective observation periods at the nine hospitals (Supplementary Table S1), and after exclusion of 2,824 patients that did not meet the inclusion criteria, 12,489 patients were available for analysis
Were observed in women with troponin levels below the AMI threshold between cardiac troponin (cTn) period and high-sensitivity cardiac troponin (hs-cTn) period (HR: 0.79 [95% CI 0.45–1.40]; hs-cTnI period (HR): 0.73 [95% CI 0.38–1.41]). In this real-life study, we investigated changes in case mix of women and men with suspected ACS admitted to CCU, their clinical management and outcome following transition from a conventional to a high-sensitivity cardiac troponin I (hs-cTnI) assay used together with sex-specific thresholds
Summary
Using high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific 99th percentiles may improve management of patients with suspected acute myocardial infarction (AMI). Based on data from SWEDEHEART registry (females, n = 4,819/males, n = 7,670), we compared periods before and after implementation of hs-cTnI assay (Abbott) using sex-specific 99th percentiles. The implementation of hs-cTnI assay together with sex-specific 99th percentiles was associated with an increase in incidence of AMI regardless of sex, but had no major impact on clinical management and prognosis. The aims with the present study were to (1) investigate differences between cTn period and hs-cTn period on proportion of AMI diagnosis in women and men, (2) assess the effect of implementation of hs-cTnI assay on in-hospital examinations and treatments in women and men, and (3) investigate whether this affected outcome in major adverse cardiac events and all-cause mortality as compared with cTn assays
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