Sex differences of troponin test performance in chest pain patients

•Large data set with routine clinical data (real life scenario)•Women are less likely to have initially elevated troponin values.•Sensitivity and PPV are lower in women as compared to men.•Sensitivity increases in women when lower cut-offs are applied.•Differences diminish in early-presenters (< 4 h) but are more pronounced in late-presenters (> 4 h).

BackgroundCurrent guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse.ObjectiveTo evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex.MethodsBetween 15th of February 2009 and 15th of February 2010, women (n = 1648) and men (n = 2305) who presented to the emergency department with chest pain (n = 3954) were enrolled.The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI; Stratus® CS, Siemens and TnT; Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed.ResultsNSTEMI was diagnosed in 7.3% (n = 287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8%; n = 202) as compared to women (5.2%; n = 85; p < 0.001). Sensitivity was 56.1% (95% CI: 44.7-67.0%) in women and 70.1% (95% CI: 63.1-76.4%) in men. Specificity was 96.8% (95% CI: 95.6-97.7%) in women and 94.5% (95% CI: 93.3-95.6%) in men. This resulted in a lower positive predictive value (PPV) for women (53.5%; 95% CI: 42.4-64.3) as compared to men (60.8%; 95% CI: 54.1-67.2) and a slightly higher negative predictive value (NPV) for women: 97.1% (95% CI: 96.0-97.9) vs. 96.3% (95% CI: 95.2-97.2) in men.ConclusionsThe findings of this study underline that the performance of cTn for the diagnosis of NSTEMI depends on a patient's sex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable.