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

• Published in: The American heart journal Vol. 166; no. 1; pp. 30 - 37
• Main Authors: Balmelli, Cathrin, MD, Meune, Christophe, MD, PhD, Twerenbold, Raphael, MD, Reichlin, Tobias, MD, Rieder, Simone, MD, Drexler, Beatrice, MD, Rubini, Maria Gimenez, MD, Mosimann, Tamina, MD, Reiter, Miriam, MD, Haaf, Philip, MD, Mueller, Mira, MD, Ernst, Susanne, MD, Ballarino, Paola, MD, Alafify, Azza A., MD, Zellweger, Christa, MD, Wildi, Karin, MD, Moehring, Berit, MD, Vilaplana, Carles, MD, Bernhard, Denise, MD, Merk, Salome, MD, Ebmeyer, Stefan, MD, Freidank, Heike, MD, Osswald, Stefan, MD, Mueller, Christian, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.2013; Elsevier Limited
• Subjects: Accuracy; Acute coronary syndromes; Aged; Cardiovascular; Cardiovascular disease; Electrocardiography; Family medical history; Female; Follow-Up Studies; Gender differences; Glycopeptides - blood; Heart attacks; Humans; Immunoassay; Laboratories; Male; Medical records; Middle Aged; Mortality; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Prognosis; Prospective Studies; Protein Precursors; Reproducibility of Results; Sex Factors; Survival Rate - trends; Switzerland - epidemiology; Troponin T - blood; Switzerland
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2013.03.014

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.