• Anoop S V Shah, Megan Griffiths, Kuan Ken Lee, David A McAllister, Amanda L Hunter, Amy V Ferry, Anne Cruikshank, Alan Reid, Mary Stoddart, Fiona Strachan, Simon Walker, Paul O Collinson, Fred S Apple, Alasdair J Gray, Keith A A Fox, David E Newby, and Nicholas L Mills.
• BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK.
• BMJ. 2015 Jan 1;350:g7873.

ObjectiveTo evaluate the diagnosis of myocardial infarction using a high sensitivity troponin I assay and sex specific diagnostic thresholds in men and women with suspected acute coronary syndrome.DesignProspective cohort study.SettingRegional cardiac centre, United Kingdom.ParticipantsConsecutive patients with suspected acute coronary syndrome (n=1126, 46% women). Two cardiologists independently adjudicated the diagnosis of myocardial infarction by using a high sensitivity troponin I assay with sex specific diagnostic thresholds (men 34 ng/L, women 16 ng/L) and compared with current practice where a contemporary assay (50 ng/L, single threshold) was used to guide care.Main Outcome MeasureDiagnosis of myocardial infarction.ResultsThe high sensitivity troponin I assay noticeably increased the diagnosis of myocardial infarction in women (from 11% to 22%; P<0.001) but had a minimal effect in men (from 19% to 21%, P=0.002). Women were less likely than men to be referred to a cardiologist or undergo coronary revascularisation (P<0.05 for both). At 12 months, women with undisclosed increases in troponin concentration (17-49 ng/L) and those with myocardial infarction (≥50 ng/L) had the highest rate of death or reinfarction compared with women without (≤16 ng/L) myocardial infarction (25%, 24%, and 4%, respectively; P<0.001).ConclusionsAlthough having little effect in men, a high sensitivity troponin assay with sex specific diagnostic thresholds may double the diagnosis of myocardial infarction in women and identify those at high risk of reinfarction and death. Whether use of sex specific diagnostic thresholds will improve outcomes and tackle inequalities in the treatment of women with suspected acute coronary syndrome requires urgent attention.© Shah et al 2015.

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