Circadian Troponin Dynamics Reveal Sex-Specific Signals for Acute Coronary Syndrome Management

Document Type

Conference Proceeding

Publication Date

11-3-2025

Publication Title

Circulation

Keywords

Acute coronary syndromes, Circadian, Sex differences, Troponin, Cardiovascular System & Cardiology

Abstract

Introduction: The circadian variation of high-sensitivity cardiac troponin has been established, but whether sex-based differences in these rhythms affect early acute coronary syndrome risk evaluation remains unknown. Research Questions: The research examines whether high-sensitivity cardiac troponin I (hs-cTnI) displays distinct diurnal patterns between men and women and investigates if these differences affect the prediction of 30-day major adverse cardiac events (MACE) for patients suspected of acute coronary syndrome independently. Methods: The RACE-IT stepped-wedge randomized trial underwent secondary analysis in nine Michigan emergency departments from July 2020 to April 2021. Our analysis included patients from the primary trial who had recorded an hs-cTnI value among 32,609 participants. All the hs-cTnI samples received timestamp data and measurements fell between 2–18 ng/L using the Beckman-Coulter assay. We used Cosinor regression models to assess diurnal variation and Cox proportional hazards models to examine the relationship with 30-day MACE while controlling for cardiovascular risk factors. Our study presented Midline Estimating Statistic Of Rhythm (MESOR) values, which show the average level of hs-cTnI throughout the day. Results: The participants had an average age of 57 years, 42% were male, and 32% were Black. Mesor hs-cTnI measurements were higher among men (6.3 ng/L versus 5.5 ng/L; p < 0.001) while their diurnal amplitude was also greater (β = 0.21 versus 0.13; p < 0.001). Peak concentrations occurred at ~06:00 h in both sexes (Figure 1). The multivariable analysis identified male sex (HR = 2.35; 95% CI: 1.67–3.31) and presentation time near midnight (per 6-hour interval HR = 0.65; 95% CI: 0.54–0.79) as independent factors predicting 30-day MACE. When hs-cTnI levels rose by 1 ng/L, patients experienced a 7% higher MACE risk, reflected by an HR of 1.07 (95% CI: 1.03–1.12). The research findings remained consistent when data were stratified by age, and patients with previous cardiovascular disease were excluded from the analysis. Conclusions: Men exhibit stronger diurnal hs-cTnI rhythms while sex and time of presentation provide separate prognostic insights. Using sex- and time-specific hs-cTnI thresholds can refine early acute coronary syndrome risk assessment and identify patients who require enhanced monitoring or treatment. Prospective studies integrating circadian biomarker patterns into diagnostic algorithms are warranted.

Volume

152

Issue

SUPPL_3

First Page

1

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