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New troponin test improves MI detection in women

As trailed widely in the media, a new high sensitivity troponin (hs-TnI) assay with sex-specific diagnostic thresholds could double the diagnosis of myocardial infarction (MI) in women and identify those at high risk of re-infarction and death, according to a study published recently in the British Medical Journal.1

The authors examined data from consecutive patients with suspected acute coronary syndrome (n=1126, 46% women). Two cardiologists independently adjudicated the diagnosis of MI by using an hs-TnI assay with sex-specific diagnostic thresholds (men 34 ng/L, women 16 ng/L) and compared with current practice where a contemporary assay (50 ng/L, single threshold) was used to guide care.

The hs-TnI assay noticeably increased the diagnosis of MI in women (from 11% to 22%; P<0.001) but had a minimal effect in men (from 19% to 21%, P=0.002). Women were less likely than men to be referred to a cardiologist or undergo coronary revascularisation (P<0.05 for both). At 12 months, women with undisclosed increases in troponin concentration (17–49 ng/L) and those with MI (≥50 ng/L) had the highest rate of death or reinfarction compared with women without (≤16 ng/L) MI (25%, 24%, and 4%, respectively; P<0.001).

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Whether use of sex-specific diagnostic thresholds will improve outcomes and tackle inequalities in the treatment of women with suspected acute coronary syndrome requires urgent attention, the authors conclude.

“Women are likely to have poorer outcomes following a heart attack compared to men of the same age,” said Dr Anoop Shah, one of the study authors from the University of Edinburgh. “While men and women are just as likely to present to the emergency department with chest pain, men are currently twice as likely to be diagnosed with a heart attack. The hs-TnI test, with gender specific thresholds for men and women, may diagnose more heart attacks in women, and identify women at high risk who may benefit from targeted evidence based therapy.”


1. Shah ASV, Griffiths M, Ken Lee K, et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. Br Med J 2015;350:g7873.

Published on: January 29, 2015

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