Clinical Investigation
Acute Ischemic Heart Disease
Comparison of the performances of cardiac troponins, including sensitive assays, and copeptin in the diagnostic of acute myocardial infarction and long-term prognosis between women and men

https://doi.org/10.1016/j.ahj.2013.03.014Get rights and content

Background

Concerns have been raised about possible gender disparities in cardiac investigations and/or outcome. This study sought to examine and compare the diagnostic and prognostic performance of selected cardiac biomarkers in women versus men.

Methods

In a prospective, multicenter cohort of patients with acute chest pain cardiac troponin T (cTnT) (fourth-generation Roche assay), high-sensitivity cTnT (hs-cTnT), and copeptin were measured at presentation.

Results

Of 1,247 patients, 420 were women and 827 were men. Although the rate of acute myocardial infarction was similar in women (14.5%) and men (16.6%, P = .351), women more frequently had cardiac but noncoronary causes of chest pain (17.4% vs 10.8%, P = .001) and less frequently had unstable angina (8.8% vs 16.6%, P = .002) than men. Diagnostic accuracy as quantified by the area under the receiver operating characteristic curve (AUC) for acute myocardial infarction in women was 0.90 (95% CI 0.84-0.95) for cTnT, which was lower than the AUC for hs-cTnT alone (0.94, 95% CI [0.91-0.98]), the combination of cTnT with copeptin (0.96, 95% CI [0.94-0.98]) or the combination of hs-cTnT with copeptin (0.96, 95% CI [0.93-0.98]) (P = .008, P = .006, and P = .002, respectively). Prognostic accuracy as quantified by the AUCs for 1-year mortality was 0.69 (0.56-0.83), 0.86 (0.79-0.93), 0.87 (0.81-0.94), and 0.87 (0.80-0.94), respectively. No relevant gender differences in AUCs were observed.

Conclusion

The diagnostic and prognostic performance of cTnT, hs-cTnT, and copeptin is as good in women as in men. High-sensitivity cTnT and the combination of cTnT and copeptin outperform cTnT alone, both in women and men.

Section snippets

Study design and population

The Advantageous Predictors of Acute Coronary Syndrome Evaluation is an ongoing prospective international multicenter study designed and coordinated by the University Hospital Basel, Switzerland.13 Briefly, consecutive patients presenting to the ED with symptoms suggestive of AMI of <12 hours have been included, after informed consent, and were followed up at regular intervals. Patients with terminal kidney failure requiring dialysis were excluded. The objective of the present study was to

Study population

A total of 1,247 patients were included in the present analysis, comprising 420 women (34%) and 827 men (66%). Baseline characteristics according to gender are listed in Table I. The adjudicated final diagnosis was AMI in 198 patients (15.9%) (14.5% in women vs 16.6% in men, P = .351), including NSTEMI in 148 patients (11.9%) (10.7% in women vs 12.4% in men, P = .369). Other diagnosis included unstable angina in 174 patients (14.0%) (8.8% in women vs 16.6% in men, P = .002), cardiac but

Discussion

We report 4 major findings. First, we found important gender differences regarding the final diagnoses underlying acute chest pain. Although women had similar rates of AMI, including NSTEMI, they more frequently had cardiac but noncoronary causes of chest pain and less frequently had unstable angina than men. Second, there was no significant difference in the diagnostic accuracy of cTnT, hs-cTnT, and copeptin, alone or in combination, in women versus men; hs-cTnT and the combination of cTn and

Acknowledgements

We thank the patients who participated in the study; the staff of the EDs; the laboratory technicians; and, particularly, Claudia Stelzig, Michael Freese, Kirsten Hochholzer, Esther Garrido, Irina Klimmeck, Melanie Wieland, and Fausta Chiaverio for their most valuable efforts, and we thank Drs C. Schindler and K. Denhaerynck for expert statistical advice.

References (27)

  • J.G. Canto et al.

    Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality

    JAMA

    (2012)
  • S. Rosato et al.

    Thirty-day mortality after AMI: effect modification by gender in outcome studies

    Eur J Public Health

    (2010)
  • J.Z. Ayanian et al.

    Differences in the use of procedures between women and men hospitalized for coronary heart disease

    N Engl J Med

    (1991)
  • Cited by (59)

    • Copeptin as a prognostic biomarker in acute myocardial infarction

      2019, International Journal of Cardiology
      Citation Excerpt :

      As such, copeptin could be considered a marker of both myocardial injury and hemodynamical stress. On the basis of the distribution of copeptin, different potential cutoff values were considered [10,30–32] and a recent systematic review [11] suggested that the use of different cut-points did not significantly impact diagnostic accuracy. In our study, the median copeptin was 36.2 pmol/L, which is higher than previous studies performed in the same clinical setting [5,15,22,33] which could be explained by the early measurement in our study as compared with the others.

    • Fourth Universal Definition of Myocardial Infarction (2018)

      2018, Global Heart
      Citation Excerpt :

      For some hs-cTn assays, sex-specific cut-off values have been reported to improve diagnostic and prognostic information in patients with possible acute MI [128,129]. However, there is controversy as to whether this approach provides valuable additional information for all hs-cTn assays [130]. Blood samples for the measurement of cTn should be drawn on first assessment (designated as 0 h) and repeated 3 – 6 h later, or earlier with hs- cTn assays.

    • Fourth Universal Definition of Myocardial Infarction (2018)

      2018, Journal of the American College of Cardiology
    View all citing articles on Scopus

    Clinical Trial Registration: http://clinicaltrials.gov/ct2/show/NCT00470587.

    k

    Both authors have contributed equally and should be considered first author.

    View full text