DOI: 10.1161/circ.148.suppl_1.15219 ISSN: 0009-7322

Abstract 15219: High-Sensitivity Cardiac Troponins and Sex-Differences in Prognostic Value for Cardiovascular Events and All-Cause Mortality

Nasir Saeed, Joerund Langoergen, Ole-Thomas Steiro, Hilde L Tjora, Rune Bjorneklett, Oyvind Skadberg, Vernon V Bonarjee, Øistein Mjelva, Tone M Norekval, Kjell Vikenes, Torbjorn Omland, Kristin Moberg M Aakre
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Cardiac troponin (cTn) concentrations and the associated long-term cardiovascular risk differ between women and men in the general population.

Research question: In patients with acute chest pain, does the prognostic value of cTn differ between sexes as assessed by different cTn assays?

Methods: This prospective cohort study included 1500 patients (906 men and 594 women) admitted with suspected NSTE-ACS. Admission cTn was measured with three different high-sensitivity assays: hs-cTnT (Roche), hs-cTnI (Siemens) and hs-cTnI (Abbott). Patients were followed for a median of 1687 (range 4-2208) days. The primary endpoint was a composite of all-cause mortality, myocardial infarction, revascularization and heart failure. The secondary endpoint was all-cause mortality. Discriminatory performance was calculated by the receiver-operating characteristics area under the curve (ROC-AUC) whilst prognostic value was calculated by hazard ratios (HR) in unadjusted and adjusted Cox proportional hazard models.

Results: The primary endpoint occurred in 18.1% of men and 15.0% of women. The secondary endpoint occurred in 10.3% of men and 8.9% of women. Women were older than men (median 65 years vs. 59 years, P<0.001), and had higher cTn concentrations (P<0.001 for all assays). All cTn assays had significantly higher discriminatory value in women compared to men for both endpoints (Table 1). Ln-transformed cTn for all assays were associated with increased risk of the primary endpoint and all-cause mortality in both sexes. Unadjusted HRs were higher in women than men with increasing hs-cTn, while in multivariate Cox model the adjusted HRs exhibited similar values between sexes (both endpoints) with no interaction between sex (P>0.05 for all) (Table 1).

Conclusions: In patients with suspected with NSTE-ACS, there is a difference in the discriminatory value of hs-cTn, but no clear trend between sexes regarding its prognostic in adjusting for a range of factors, including age.

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