Available studies do not show a consistent clinical superiority of sex-specific high-sensitivity cardiac troponin 99th percentiles, despite men generally having higher concentrations than women.
Do sex-specific cutoffs for high-sensitivity cardiac troponin improve clinical decision-making and outcomes compared to uniform cutoffs?
Current evidence does not consistently support the clinical superiority of sex-specific high-sensitivity cardiac troponin cutoffs, though they may be pathobiologically appropriate for ruling in myocardial infarction.
BACKGROUND: The use of sex-specific cutoffs for cardiac troponin (cTn) is currently debated. Although endorsed by scientific working groups, concerns have been raised that sex-specific cutoffs may have only a small clinical effect at the cost of increased complexity in decision-making. METHODS: We reviewed studies investigating the interrelations between high-sensitivity (hs) cTn results and sex, diagnoses, and outcome. Investigated populations included community-dwelling subjects and patients with stable angina, congestive heart failure, or acute chest pain including those with acute coronary syndromes. RESULTS: Men usually have higher hs-cTn concentrations compared with women, regardless of the assessed population or the applied assay. The distribution and prognostic implications of hs-cTn concentrations indicate that women have a broader cardiovascular risk panorama compared with men, particularly at lower hs-cTn concentrations. At higher concentrations, particularly above the 99th percentile, this variation is often attenuated. Sex-specific hs-cTn 99th percentiles have so far shown clinical net benefit in only 1 study assessing patients with chest pain. However, several methodological aspects need to be considered when interpreting study results, e.g., issues related to the determination of the 99th percentiles, the selection bias, and the lack of prospective and sufficiently powered analyses. CONCLUSIONS: Available studies do not show a consistent clinical superiority of sex-specific hs-cTn 99th percentiles. This may reflect methodological aspects. However, from a pathobiological perspective, the use of sex-specific hs-cTn 99th percentiles makes sense for the ruling in of myocardial infarction. We propose a new approach to hs-cTn 99th cutoffs taking into account the analytical properties of the used assays.
Eggers et al. (2017) conducted a review in Community-dwelling subjects and patients with stable angina, congestive heart failure, or acute chest pain including acute coronary syndromes. Sex-specific high-sensitivity cardiac troponin (hs-cTn) cutoffs was evaluated. Available studies do not show a consistent clinical superiority of sex-specific high-sensitivity cardiac troponin 99th percentiles, despite men generally having higher concentrations than women.