Utility of gender-specific HS-troponin I cut-points for AMI diagnosis
Fram G, Hudson MP, McCord J, Moyer M, Jacobsen G, and Nowak RM. Utility of gender-specific HS-troponin I cut-points for AMI diagnosis. Journal of the American College of Cardiology 2020; 75(11):64.
J Am Coll Cardiol
Background Circulating concentrations of high sensitivity cardiac troponin I (hs-cTnI) are higher in men than women during normal conditions and acute coronary syndromes. There is clinical uncertainty whether gender-specific vs. single gender-neutral hs-cTnI cut-off values more effectively diagnose acute myocardial infarction (AMI). Methods Emergency department patients with suspected coronary ischemia and no ST-segment elevation underwent clinical evaluation plus serial hs-cTnI testing (Abbott Architect, 99th percentile women 16 ng/L, men 34 ng/L) at baseline, 1 hour, and 3 hours. Final diagnosis of AMI was centrally adjudicated by 2 independent cardiologists using the Fourth Universal Definition of AMI, clinical information, and serial hs-cTnI results. We compared the diagnostic accuracy of a single, general hs-cTnI cut-point of >26.0 ng/L, versus gender-specific cut-points (>16.0 ng/l for females and >34.0 ng/l for males) to diagnose AMI. Results The study population included 569 patients (48% female) with an adjudicated AMI diagnosis in 42 patients (7.4%). A single, general hs-cTnI cut-off value demonstrated a sensitivity of 97.6%, specificity of 87.3%, positive predictive value (PPV) of 38.0%, and negative predictive value (NPV) of 99.8% for AMI diagnosis. Gender-specific cut-off values did not change AMI diagnosis in any male patients and identified 1 additional female AMI patient. Additionally, among females there were 17 more false positives (FP), and among males there were 9 less FPs. Gender-specific hs-cTnI criteria demonstrated a sensitivity of 100%, specificity of 85.8%, PPV 35.9%, and NPV 100% for AMI diagnosis. There was no significant difference in sensitivity, specificity, PPV, or NPV using the gender-specific versus the general cut-point values (p = 1.000, p = 0.471, p = 0.748, and p = 1.000 respectively). Conclusion Our study reveals no significant AMI diagnostic difference using a single, gender-neutral hs-cTnI cut-point versus separate gender-specific hs-cTnI criteria. Emergency Department and Cardiology providers may implement hs-cTnI testing algorithms with single, gender-neutral cut-off values to diagnose or exclude AMI.