Sex-specific versus overall clinical decision limits for Cardiac Troponin i and T for the diagnosis of acute myocardial infarction: A systematic review

Dorien M. Kimenai, Emma B. N. J. Janssen, Kai M. Eggers, Bertil Lindahl, Hester M. den Ruijter, Otto Bekers, Yolande Appelman, Steven J. R. Meex

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

BACKGROUND: The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations. CONTENT: We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23-30 ng/L; hs-cTnT, 13-25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5%) and 11 (61.1%) studies reported lower femalespecific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90% concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4% vs 80.0% of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively). SUMMARY: Our data show substantially lower femalespecific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.
Original languageEnglish
Pages (from-to)1034-1043
JournalClinical Chemistry
Volume64
Issue number7
DOIs
Publication statusPublished - 2018

Cite this

Kimenai, D. M., Janssen, E. B. N. J., Eggers, K. M., Lindahl, B., den Ruijter, H. M., Bekers, O., ... Meex, S. J. R. (2018). Sex-specific versus overall clinical decision limits for Cardiac Troponin i and T for the diagnosis of acute myocardial infarction: A systematic review. Clinical Chemistry, 64(7), 1034-1043. https://doi.org/10.1373/clinchem.2018.286781
Kimenai, Dorien M. ; Janssen, Emma B. N. J. ; Eggers, Kai M. ; Lindahl, Bertil ; den Ruijter, Hester M. ; Bekers, Otto ; Appelman, Yolande ; Meex, Steven J. R. / Sex-specific versus overall clinical decision limits for Cardiac Troponin i and T for the diagnosis of acute myocardial infarction: A systematic review. In: Clinical Chemistry. 2018 ; Vol. 64, No. 7. pp. 1034-1043.
@article{ca54d04830da43298d9bb277695eaaf6,
title = "Sex-specific versus overall clinical decision limits for Cardiac Troponin i and T for the diagnosis of acute myocardial infarction: A systematic review",
abstract = "BACKGROUND: The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations. CONTENT: We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23-30 ng/L; hs-cTnT, 13-25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5{\%}) and 11 (61.1{\%}) studies reported lower femalespecific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90{\%} concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4{\%} vs 80.0{\%} of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively). SUMMARY: Our data show substantially lower femalespecific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.",
author = "Kimenai, {Dorien M.} and Janssen, {Emma B. N. J.} and Eggers, {Kai M.} and Bertil Lindahl and {den Ruijter}, {Hester M.} and Otto Bekers and Yolande Appelman and Meex, {Steven J. R.}",
year = "2018",
doi = "10.1373/clinchem.2018.286781",
language = "English",
volume = "64",
pages = "1034--1043",
journal = "Clinical Chemistry",
issn = "0009-9147",
number = "7",

}

Sex-specific versus overall clinical decision limits for Cardiac Troponin i and T for the diagnosis of acute myocardial infarction: A systematic review. / Kimenai, Dorien M.; Janssen, Emma B. N. J.; Eggers, Kai M.; Lindahl, Bertil; den Ruijter, Hester M.; Bekers, Otto; Appelman, Yolande; Meex, Steven J. R.

In: Clinical Chemistry, Vol. 64, No. 7, 2018, p. 1034-1043.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Sex-specific versus overall clinical decision limits for Cardiac Troponin i and T for the diagnosis of acute myocardial infarction: A systematic review

AU - Kimenai, Dorien M.

AU - Janssen, Emma B. N. J.

AU - Eggers, Kai M.

AU - Lindahl, Bertil

AU - den Ruijter, Hester M.

AU - Bekers, Otto

AU - Appelman, Yolande

AU - Meex, Steven J. R.

PY - 2018

Y1 - 2018

N2 - BACKGROUND: The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations. CONTENT: We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23-30 ng/L; hs-cTnT, 13-25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5%) and 11 (61.1%) studies reported lower femalespecific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90% concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4% vs 80.0% of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively). SUMMARY: Our data show substantially lower femalespecific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.

AB - BACKGROUND: The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations. CONTENT: We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23-30 ng/L; hs-cTnT, 13-25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5%) and 11 (61.1%) studies reported lower femalespecific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90% concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4% vs 80.0% of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively). SUMMARY: Our data show substantially lower femalespecific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85049406564&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/29844245

U2 - 10.1373/clinchem.2018.286781

DO - 10.1373/clinchem.2018.286781

M3 - Review article

VL - 64

SP - 1034

EP - 1043

JO - Clinical Chemistry

JF - Clinical Chemistry

SN - 0009-9147

IS - 7

ER -