86 Do sex-specific high sensitivity troponin cut points improve safety and efficacy?
Recommended Citation
Montgomery C, Ashburn NP, Snavely AC, Allen BR, Christenson RH, Madsen T, McCord J, Mumma BE, Hashemian T, Supples MW, Stopyra JP, Wilkerson R, Mahler SA. 86 Do sex-specific high sensitivity troponin cut points improve safety and efficacy?. Acad Emerg Med 2024; 31(S1):47.
Document Type
Conference Proceeding
Publication Date
4-27-2024
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: Data comparing the performance of sex-specific to non-sex-specific high-sensitivity cardiac troponin (hs-cTn) cut-points for diagnosing acute coronary syndrome (ACS) are limited. This study evaluated the safety (30-day cardiac death or myocardial infarction [MI]) and efficacy (rule-out rate) when using sex-specific vs. non-sex-specific (overall) 99th percentile hs-cTnT cut-points. Methods: We conducted a secondary analysis of the STOP-CP cohort, which prospectively enrolled adult ED patients with possible ACS across 8 U.S. sites (1/25/2017–9/6/2018). Participants with both 0- and 1-h hs-cTnT measures (Roche, Basel, Switzerland) less than the 99th percentile were classified into the rule-out group. The 99th percentile was defined using (1) a sex-specific strategy using a 99th percentile of 22?ng/L for males and 14?ng/L for females and (2) an overall strategy using a 99th percentile of 19?ng/L. The safety outcome was adjudicated cardiac death or MI at 30?days. Efficacy was determined by the proportion classified to the rule-out group. McNemar's test compared rule-out rates between strategies. Negative predictive values (NPV) with 95% confidence intervals were calculated and compared using a generalized score statistic. The net reclassification improvement (NRI) index further compared performance. Results: During the study period 1430 patients were enrolled, of which 45.8% (655/1430) were female and the mean age was 57.6?±?12.8?years. At 30?days, cardiac death or MI occurred in 12.8% (183/1430). The rule-out rate was lower when using sex-specific vs. overall cut-points (69.2% [990/1430] vs. 71.7% [1025/1430]; p?
Volume
31
Issue
S1
First Page
47
