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

Study Questions:

What is 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. The coprimary diagnostic endpoints were the accurate detection of patients with acute myocardial infarction (AMI) and non–ST-segment elevation AMI (NSTEMI). The primary prognostic endpoint was all-cause mortality within 360 days. Secondary prognostic endpoints were combined death/AMI within 360 days. Receiver operating characteristic curves were constructed to assess the sensitivities and specificities of cTnT, hs-cTnT, and copeptin for both diagnostic and prognostic purposes; and their accuracy was compared in women versus men.

Results:

Of 1,247 patients, 420 were women and 827 were men. Although the rate of AMI was similar in women (14.5%) and men (16.6%, p = 0.351), 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 = 0.002) than men. Diagnostic accuracy as quantified by the area under the receiver operating characteristic curve (AUC) for AMI in women was 0.90 (95% confidence interval [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 = 0.008, p = 0.006, and p = 0.002, respectively). Prognostic accuracy as quantified by the AUCs for 1-year mortality was 0.69 (95% CI, 0.56-0.83), 0.86 (95% CI, 0.79-0.93), 0.87 (95% CI, 0.81-0.94), and 0.87 (95% CI, 0.80-0.94), respectively. No relevant gender differences in AUCs were observed.

Conclusions:

The authors concluded that diagnostic and prognostic performance of cTnT, hs-cTnT, and copeptin is as good in women as in men.

Perspective:

This study reported that there was no significant difference in the diagnostic accuracy of cTnT, hs-cTnT, and copeptin, alone or in combination, in women versus men; hs-cTnT and the combination of cTn and copeptin outperformed the diagnostic accuracy of cTn alone. Furthermore, the prognostic accuracy offered by cTnT, hs-cTnT, and copeptin was similar in women and men. These findings have important clinical implications since the role of cardiac biomarkers may be even more important in women because they more likely than men report atypical symptoms, such as dyspnea, weakness, nausea, and back pain, which may delay accurate diagnosis.

Clinical Topics: Heart Failure and Cardiomyopathies, Heart Failure and Cardiac Biomarkers

Keywords: Nausea, Myocardial Infarction, Area Under Curve, Sensitivity and Specificity, Troponin T, Back Pain, Dyspnea, Prognosis, Biological Markers, Chest Pain, ROC Curve, Confidence Intervals


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