Key result
Increasing concentrations of hs-cTnT, hs-cTnI, and NT-proBNP were associated with a higher risk of death and CV events in women than in men presenting with suspected NSTE-ACS (P=0.009 for hs-cTnT).
Why the study?
Biomarkers are used for long-term risk prediction of cardiovascular events in suspected ACS, but potential sex differences in their prognostic value in suspected NSTE-ACS required investigation.
Are there sex differences in the long-term prognostic value of circulating biomarkers in patients presenting with suspected NSTE-ACS?
Cohort (n=1,476)
Are there sex differences in the long-term prognostic value of circulating biomarkers in patients presenting with suspected NSTE-ACS?
Elevated concentrations of hs-cTn and NT-proBNP confer a higher relative risk of long-term adverse cardiovascular events in women than in men presenting with suspected NSTE-ACS, suggesting sex-adjustment may improve prognostication.
May warrant sex-specific biomarker thresholds in suspected NSTE-ACS; extends observational associations but leaves open prospective validation.
BACKGROUND: Biomarkers are used for long-term risk prediction of cardiovascular (CV) events in patients presenting with suspected acute coronary syndromes. OBJECTIVES: This study investigated whether there are sex differences in the long-term prognostic value of biomarkers in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: High-sensitivity cardiac troponin T (hs-cTnT), hs-cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor (GDF)-15, and C-reactive protein (CRP) concentrations were measured in 1,476 patients admitted with suspected NSTE-ACS. Patients were followed up for a median of 1,547 (IQR: 873-1,842) days until a primary composite endpoint of all-cause mortality, incident myocardial infarction, or heart failure hospitalization. A secondary endpoint of CV death was also registered. RESULTS: For the primary endpoint, a log2 increase of hs-cTnT and hs-cTnI concentration was associated with a higher adjusted HR in women (hs-cTnT: 1.3, 95% CI: 1.2-1.5; hs-cTnI: 1.2, 95% CI: 1.1-1.2) than in men (hs-cTnT: 1.1, 95% CI: 1.0-1.2; hs-cTnI: 1.0, 95% CI: 1.0-1.1); P for interaction with sex = 0.009 (hs-cTnT) and 0.005 (hs-cTnI). A similar interaction was shown for NT-proBNP (P for interaction = 0.043). GDF-15 and CRP were independent predictors of the primary endpoint, but the interaction by sex was nonsignificant. CONCLUSIONS: In contrast to CRP and GDF-15, increasing concentrations of hs-cTnT, hs-cTnI, and NT-proBNP are associated with higher risk of death and CV events in female than in male patients presenting with suspected NSTE-ACS. Sex-adjustment of hs-cTn and NT-proBNP may increase the accuracy of long-term CV prognostication in women and men.
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Myrmel et al. (2025) conducted a cohort in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=1,476). Circulating biomarkers (hs-cTnT, hs-cTnI, NT-proBNP, GDF-15, CRP) vs. Men (sex differences) was evaluated on composite of all-cause mortality, incident myocardial infarction, or heart failure hospitalization (HR 1.3 (women) vs 1.1 (men) for hs-cTnT, 95% CI 1.2-1.5 (women) vs 1.0-1.2 (men), p=0.009 for interaction). Increasing concentrations of hs-cTnT, hs-cTnI, and NT-proBNP were associated with a higher risk of death and CV events in women than in men presenting with suspected NSTE-ACS (P=0.009 for hs-cTnT).
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