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Implications of Alternative Definitions of Peri-Procedural Myocardial Infarction After Coronary Revascularization Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014 Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial Open sesame technique in percutaneous coronary intervention for ST-elevation myocardial infarction Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection Use of Mechanical Circulatory Support Devices Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Expert OpinionApril 24, 2018, Volume 137, Issue 17

JOURNAL：Circulation. Article Link

Impact of the US Food and Drug Administration–Approved Sex-Specific Cutoff Values for High-Sensitivity Cardiac Troponin T to Diagnose Myocardial Infarction

MR Gimenez, P Badertscher, R Twerenbold et al. Keywords: myocardial infarction; troponin

ABSTRACT

In patients presenting with suspected myocardial infarction (MI), beyond the presence or absence of MI, 4 clinical variables seem to affect high-sensitivity cardiac troponin (hs-cTn) concentrations: age, renal dysfunction, time from chest pain onset, and sex.1 Among the 4 variables, sex has received the most attention, resulting in uncertainty about the need to abandon the 1 overall cutoff in favor of sex-specific cutoffs for hs-cTn in the diagnosis of MI.2,3 For high-sensitivity cardiac troponin T (hs-cTnT), the only hs-cTn assay approved by the US Food and Drug Administration (FDA) until now, this does not seem necessary when applying 99th percentiles of healthy individuals, as done outside the United States. With these cutoffs, only a very small percentage (<1%) of women were reclassified as having MI.2 The FDA-approved use of hs-cTnT differs in using the 99th percentile upper reference limit determined in a reference population matched to the age of patients presenting with suspected MI to the emergency department. As a consequence, the FDA-approved 1 overall (19 ng/L) and sex-specific (women, 14 ng/L; men, 22 ng/L) 99th percentiles are higher compared with the 99th percentiles used outside the United States.

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