ACC 2024: Uniform High-Sensitivity Cardiac Troponin I Threshold Safe, Effective for Ruling Out Myocardial Infarction in Men and Women
Findings seen for patients presenting to the emergency department with possible myocardial infarction
WEDNESDAY, April 10, 2024 (HealthDay News) -- A uniform high-sensitivity cardiac troponin I rule-out threshold for myocardial infarction (MI) is safe and effective for identifying low-risk men and women presenting to the emergency department, according to a study published online March 25 in the Journal of the American College of Cardiology to coincide with the annual American College of Cardiology Scientific Session, held from April 6 to 8 in Atlanta.
Ziwen Li, Ph.D., from University of Edinburgh in the United Kingdom, and colleagues evaluated implementation of a uniform rule-out threshold (<5 ng/L with a high-sensitivity cardiac troponin I assay) in women and men with possible MI and derived and validated sex-specific thresholds. The analysis included 16,792 patients presenting to the emergency department with possible MI.
The researchers found that the uniform threshold identified more female than male patients as low-risk (73 versus 62 percent). However, a similar proportion of low-risk patients were discharged from the emergency department (81 percent for both), with fewer than five patients (<0.1 percent) having a subsequent MI or cardiac death at 30 days. The authors observed that use of sex-specific thresholds would increase the proportion of female patients (61.8 versus 65.9 percent) and reduce the proportion of male patients (54.8 versus 47.8 percent) identified as low-risk compared with use of the uniform threshold.
“Compared to a uniform rule-out threshold, sex-specific rule-out threshold would reclassify four in 100 additional females and seven in 100 fewer males as suitable for safe early discharge, rendering the net benefit in effectiveness likely negligible,” senior author Dorien Kimenai, Ph.D., also from University of Edinburgh, told Elsevier’s PracticeUpdate. “We are hoping to send a clear message to our colleagues in the emergency department that a low, uniform rule-out threshold is effective and safe; but sex-specific rule-out thresholds should be considered where feasible.”
Several authors disclosed ties to the pharmaceutical industry.
Abstract/Full Text (subscription or payment may be required)
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts