Abstract 13919: Race and Gender Specific High Sensitivity Troponin-t Cutoff Values Improve Detection in Patients’ With Ischemic Heart Disease

Abstract

Introduction: Death rates from acute coronary syndrome events (ASCE) are 30% higher in African Americans than in Caucasians. A potential reason for this disparity is the underdiagnosis of ACSE due to race-specific differences in blood levels of cardiac troponin-T (cTnT), the biomarker of choice for the exclusion of myocardial injury. Hypothesis: Race- and gender-specific high-sensitivity cTnT (hs-cTnT) cutoff values will improve the detection of myocardial injury. Methods: Emergency Department encounters at the University of Chicago from June 2018 through April 2019 with at least 1 hs-cTnT value were included. Race- and gender-specific 99 th percentiles for hs-cTnT were determined for patients without a history of hypertension, heart failure, coronary artery disease, diabetes, or chronic kidney disease, and used as the threshold for a positive result. These threshold values were compared against manufacturer’s recommended gender-only values (male ≥ 22 ng/dL, female ≥ 14 ng/dL). Confusion matrices were used to calculate test characteristics. The presence of ischemic heart disease was determined by the corresponding International Statistical Classification of Diseases. Results: Among 10,934 included encounters, 89.9% were African American. The 99 th percentile values for African American were lower than for matched white counterparts. Race and gender specific cutoffs had higher specificity (83.1% vs 75.2%), greater positive predictive value (91.9% vs 90.7%), and lower false negative rates (16.9% vs. 24.8%) compared with traditional gender-only cutoff values. During the 10 months of data collection, race- and gender-specific cutoffs would have correctly identified 215 additional encounters as having ischemic heart disease, all of them African Americans. The net reclassification rate was +7.91%. Conclusions: Using race-specific, in addition to traditional gender-specific, hs-cTnT cutoff values resulted in higher specificity, greater positive predictive value, and lower false negative rates. Nearly 8% of patients with eventual diagnosis of ischemic heart disease would have been correctly reclassified using race- and gender-specific cutoffs. These findings suggest that race- and gender-specific cutoffs should be further explored.

Sex and race differences in the performance of the European Society of Cardiology 0/1‐h algorithm with high‐sensitivity troponin T

“…However, it is unclear whether diagnostic performance was consistent across key patient subgroups, such as men, women, white patients, and non‐white patients and there is a paucity of prior data evaluating sex or race differences in algorithm performance. Prior studies have demonstrated significant differences in 99th percentile hs‐cTnT values among men versus women and white patients versus non‐white patients 15–18 . In addition, it has been hypothesized that greater racial diversity of US ED patients may explain differences in the diagnostic performance of the ESC 0/1‐h algorithm in the United States versus Europe and Australasia.…”

“…Prior studies have demonstrated significant differences in 99th percentile hs‐cTnT values among men versus women and white patients versus non‐white patients. 15 , 16 , 17 , 18 In addition, it has been hypothesized that greater racial diversity of US ED patients may explain differences in the diagnostic performance of the ESC 0/1‐h algorithm in the United States versus Europe and Australasia. Thus, it is plausible that the performance of the ESC 0/1‐h algorithm may differ based on demographics.…”