Point: The Use of Sex-Specific Cutpoints for High-Sensitivity Cardiac Troponin Assays

[摘要] Sex-specific reference intervals for cardiac troponin exist, with the 99th percentile (the cutpoint for determination of an increased troponin) being substantially lower in females than males (1, 2). Although recent guidelines have recommended their use (3, 4), clinical utilization of sex-specific ranges is limited. Troponin is engrained in our assessment of risk, diagnosis of disease, treatment options, and determination of prognosis (5). Irrespective of sex, the risk of acute myocardial infarction (AMI),3 cardiovascular death, recurrent MI, refractory ischemia, and rehospitalization increases with increasing troponin concentrations. The finding of an increased troponin often leads to targeted medical interventions designed to improve outcomes. The definition of an increased troponin is critical; if the cutpoint is set too high, there is the potential for missed diagnoses, leading to fewer receiving guideline-recommended management, and poorer outcomes. Currently women with acute coronary syndromes (ACS) receive less guideline-recommended treatment and have worse outcomes than men (6).Many assume that men have higher rates of MI compared with women. This is not supported by WHO statistics that report the proportion of men and women dying from coronary heart disease (CHD) in Europe are identical at 20% and 22% respectively (7). It is postulated that in the acute setting fewer women are evaluated for CHD owing to atypical symptoms and fewer electrocardiogram abnormalities than men (8). However, given troponin is integral to the diagnosis of AMI (4), it may also be that sex-specific differences in troponin cutoffs have contributed to differences in diagnostic rates. Women are known to have lower cardiac troponin values than men for any given extent of coronary artery disease (9) and this may result in fewer women being identified as high risk.Indeed, Shah et al. (10) investigated 1126 consecutive patients with suspected ACS. Clinical care was guided by a …

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