Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction

Giménez, María Rubini; Reiter, Miriam; Twerenbold, Raphael; Reichlin, Tobias; Wildi, Karin; Haaf, Philip; Wicki, Katharina; Zellweger, Christa; Hoeller, Rebeca; Moehring, Berit; Sou, Seoung Mann; Mueller, Mira; Denhaerynck, Kris; Meller, B.; Stallone, Fabio; Henseler, Sarah; Bassetti, Stefano; Geigy, Nicolas; Oßwald, Stefan; Müeller, Christian

doi:10.1001/jamainternmed.2013.12199

Cited by 118 publications

(54 citation statements)

References 45 publications

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“…The results of this study should highlight that although hs-cTnI can contribute to the diagnosis of acute myocardial infarction, frontline clinical staff should use this test in conjunction with other key factors, such as clinical history and other investigations 92425294647484950. At present, using the 99th centile to help rule out a diagnosis of acute myocardial infarction is clear cut and is based on a “healthy” reference population.…”

Section: Discussionmentioning

confidence: 97%

True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study

Mariathas

Allan

Ramamoorthy

et al. 2019

BMJ

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ObjectiveTo determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital.DesignProspective, observational cohort study.SettingUniversity Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017.Participants20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons.Main outcome measuresDistribution of hs-cTnI concentrations of all study participants and specifically the 99th centile.ResultsThe 99th centile of hs-cTnI for the whole population was 296 ng/L compared with the manufacturer’s quoted level of 40 ng/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng/L for the remainder (n=18 171). The 99th centile was 563 ng/L for inpatients (n=4759) and 65 ng/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN.ConclusionsOf 20 000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation.Trial registrationClinicaltrials.govNCT03047785.

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Section: Discussionmentioning

confidence: 97%

True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study

Mariathas

Allan

Ramamoorthy

et al. 2019

BMJ

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“…[184][185][186] Although most patients with AMI present with typical chest pain or chest discomfort, women often present with atypical chest pain and anginaequivalent symptoms such as dyspnea, weakness, fatigue, and indigestion, as illustrated in Table 1. 187 Sex differences in clinical presentation have consequences for timely identification of ischemic symptoms, appropriate triage, and judicious diagnostic testing and management.…”

Section: Clinical Presentationmentioning

confidence: 99%

Acute Myocardial Infarction in Women

Mehta¹,

Beckie²,

DeVon³

et al. 2016

Circulation

906

393

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Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

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“…In particular, this may occur in women who present with initial troponin concentrations below the overall 99th percentile cut point but higher than the sex-specific 99th percentile value for women. Recent studies have had mixed findings, with some reporting a benefit in using sex-specific cut points for females4 10 and others suggesting this may have little clinical impact 5 11. Longer-term studies of prediction of risk which could identify the utility of the use of sex-specific cut points have yet to be undertaken.…”

Section: Introductionmentioning

confidence: 99%

Sex-specific versus overall cut points for a high sensitivity troponin I assay in predicting 1-year outcomes in emergency patients presenting with chest pain

Cullen

Greenslade

Carlton

et al. 2016

Heart

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Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction

Cited by 118 publications

References 45 publications

True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study

True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study

Acute Myocardial Infarction in Women

Sex-specific versus overall cut points for a high sensitivity troponin I assay in predicting 1-year outcomes in emergency patients presenting with chest pain

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