Abstract:BACKGROUND:A new, high-sensitivity assay for cardiac troponin I (hs-cTnI) permits evaluation of the prognostic value of cardiac troponins within the reference interval. Men have higher hs-cTnI concentrations than women, but the underlying pathophysiological mechanisms and prognostic implications are unclear. The aim of this study was to assess the potential impact of sex on the association between hs-cTnI and cardiovascular death.
“…Moreover, the cutoff of high-sensitivity cTn that was applied in our study exceeds age-and sex-specific cutoffs that have been advocated for diagnosis of MI. [34][35][36] Third, 41% of the enrolled AIS patients received intravenous thrombolysis before coronary angiography, which may lead to improved TIMI flow rates. In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a significantly higher rate of TIMI III flow was found in patients with ST-segment elevation MI randomized to fibrinolysis before percutaneous coronary intervention.…”
Background-A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown.
“…Moreover, the cutoff of high-sensitivity cTn that was applied in our study exceeds age-and sex-specific cutoffs that have been advocated for diagnosis of MI. [34][35][36] Third, 41% of the enrolled AIS patients received intravenous thrombolysis before coronary angiography, which may lead to improved TIMI flow rates. In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a significantly higher rate of TIMI III flow was found in patients with ST-segment elevation MI randomized to fibrinolysis before percutaneous coronary intervention.…”
Background-A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown.
“…13 Mortality status was also obtained for all participants as previously reported. 11 Data are given as either median (IQR) or absolute numbers (proportion). Continuous variables were analysed using the Mann-Whitney U test and the Kruskal-Wallis Test, and categorical variables with the Pearson Chi-Square test and the Fisher exact test, where appropriate.…”
Section: Methodsmentioning
confidence: 99%
“…[8][9][10] More recent studies show a profound sex difference in the prognostic ability of hsTnI on cardiovascular death, with an apparent stronger effect in women. 11 However, it remains unclear whether the stronger association between hs-TnI and cardiovascular death in women is based on the ability of hs-TnI to predict myocardial infarction (MI) or HF. To further elucidate this effect of sex, we investigated the association between hs-TnI and incident MI and HF in women and men.…”
Section: A N U S C R I P Tmentioning
confidence: 99%
“…hs-TnI was measured using an assay from Abbott Diagnostics: ARCHITECT STAT High Sensitive Troponin, details regarding analyses have recently been published elsewhere. 11 The Modification of Diet in Only hospitalizations where these diagnoses were listed as the primary diagnosis were included. Data was obtained by linking the HUNT database to hospital databases in the county of Nord-Trøndelag, as described previously.…”
“…The rate of detection of cTn in a "normal" population of 524 presumably healthy North American individuals ranged from 0-35% with the available assays for both cTnI and cTnT, and only one of those was able to detect cTnI in as many as 96% individuals in that cohort. Despite the frequency of detectable cTn in the general population largely depends on selection criteria (14-16), a very high rate of positivity has been observed in ensuing studies carried out in representative samples of the general population (17)(18)(19)(20), as well as in the pediatric age (21,22) (Figure 1).…”
Very seldom, if ever, a single laboratory test has provided such a paradigm shift in the managed care as cardiac troponin (cTn) testing. More than twenty years of improvements in test design and analytical features have contributed to revolutionize the clinical recommendations and guidelines, and the diagnosis of myocardial infarction (MI) is now highly dependent upon the kinetics of cTn within a suggestive clinical setting. Despite the advent of high-sensitivity cTn (HS-cTn) immunoassays has allowed a more accurate and timely diagnosis as well as a higher prognostic accuracy, the focus is now shifting on the most suitable algorithms and on a comprehensive approach to the clinical management of acute coronary syndrome (ACS). In this article we aim to discuss the implications of HS-cTn testing for ruling out and ruling in ACS. In the latter instance, main improvements are related to ACS diagnosis in women, in whom this pathology is still often underdiagnosed or misdiagnosed. A quick and accurate rule out will also regarded as a great advantage from both an organizational and economic standpoint.The advantages that will stem from this new approach have been recently assessed, and shortening of repeated testing 1 or 2 h from conventional algorithms entailing blood sampling at 3 and 6 h seems attainable. The larger benefits will definitely occur in clinical settings where the actual diagnosis rate of MI among patients with suspect ACS is lower and, consequently, the negative predictive value (NPV) of HS-cTn is the highest.
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