Slagman, Anna, Searle, Julia, Vollert, Jörn O., Storchmann, Harald, Büschenfelde, Dirk Myer zum, von Recum, Johannes, Vlasny, Daniela, Ale-Abaei, Angela, Koch, Mattias, Müller, Christian, Müller, Reinhold, Somasundaram, Rajan, and Möckel, Martin (2015) Sex differences of troponin test performance in chest pain patients. International Journal of Cardiology, 187. pp. 246-251.

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Abstract

Background: Current guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse.

Objective: To evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex.

Methods: Between 15th of February 2009 and 15th of February 2010, women (n = 1648) and men (n = 2305) who presented to the emergency department with chest pain (n = 3954) were enrolled. The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI; Stratus® CS, Siemens and TnT; Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed.

Results: NSTEMI was diagnosed in 7.3% (n = 287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8%; n = 202) as compared to women (5.2%; n = 85; p < 0.001). Sensitivity was 56.1% (95% CI: 44.7–67.0%) in women and 70.1% (95% CI: 63.1–76.4%) in men. Specificity was 96.8% (95% CI: 95.6–97.7%) in women and 94.5% (95% CI: 93.3–95.6%) in men. This resulted in a lower positive predictive value (PPV) for women (53.5%; 95% CI: 42.4–64.3) as compared to men (60.8%; 95% CI: 54.1–67.2) and a slightly higher negative predictive value (NPV) for women: 97.1% (95% CI: 96.0–97.9) vs. 96.3% (95% CI: 95.2–97.2) in men.

Conclusions: The findings of this study underline that the performance of cTn for the diagnosis of NSTEMI depends on a patient's sex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable.

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