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Sex-Specific Cut-Offs for High-Sensitivity Cardiac Troponin: Is Less More?
Giulio Francesco Romiti1, Roberto Cangemi1, Filippo Toriello2
1Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy.
Insights
Sex-specific cut-offs for high-sensitivity cardiac troponin (hs-cTn) assays are crucial for accurately diagnosing myocardial infarction in women. This review examines evidence for tailored thresholds to improve female cardiac diagnosis and reduce inequality.
Area of Science:
- Cardiology
- Biochemistry
- Emergency Medicine
Background:
- Chest pain management in Emergency Departments is evolving.
- High-sensitivity cardiac troponin (hs-cTn) assays aid acute coronary syndrome risk assessment.
- Concerns exist regarding the broad application of simplified hs-cTn algorithms in diverse populations.
Purpose of the Study:
- To review current evidence on sex-specific cut-off values for hs-cTn.
- To assess the clinical application and utility of these tailored thresholds.
- To explore underlying mechanisms for sex differences in hs-cTn and debated issues.
Main Methods:
- Literature review of current evidence on sex-specific hs-cTn cut-offs.
- Overview of reported thresholds and their underlying biological mechanisms.
- Analysis of clinical practice implications and diagnostic performance in females.
Main Results:
- Potential underdiagnosis of myocardial infarction in women due to standardized hs-cTn thresholds.
- Evidence suggests lower hs-cTn thresholds may be more appropriate for females.
- Sex-tailored cut-offs aim to reduce diagnostic inequality and improve accuracy in women.
Conclusions:
- Implementing sex-specific hs-cTn cut-offs is essential for equitable and effective myocardial infarction diagnosis.
- Further research and clinical validation are needed to optimize sex-tailored approaches.
- Addressing sex differences in hs-cTn is critical for improving cardiac care for women.
Abstract:
Management of patients presenting to the Emergency Department with chest pain is continuously evolving. In the setting of acute coronary syndrome, the availability of high-sensitivity cardiac troponin assays (hs-cTn) has allowed for the development of algorithms aimed at rapidly assessing the risk of an ongoing myocardial infarction. However, concerns were raised about the massive application of such a simplified approach to heterogeneous real-world populations. As a result, there is a potential risk of underdiagnosis in several clusters of patients, including women, for whom a lower threshold for hs-cTn was suggested to be more appropriate. Implementation in clinical practice of sex-tailored cut-off values for hs-cTn represents a hot topic due to the need to reduce inequality and improve diagnostic performance in females. The aim of this review is to summarize current evidence on sex-specific cut-off values of hs-cTn and their application and usefulness in clinical practice. We also offer an extensive overview of thresholds reported in literature and of the mechanisms underlying such differences among sexes, suggesting possible explanations about debated issues.
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