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

被引:58
作者
Balmelli, Cathrin [1 ]
Meune, Christophe [2 ,3 ]
Twerenbold, Raphael [4 ]
Reichlin, Tobias [1 ]
Rieder, Simone [1 ]
Drexler, Beatrice [1 ]
Rubini, Maria Gimenez [1 ]
Mosimann, Tamina [1 ]
Reiter, Miriam [1 ]
Haaf, Philip [1 ]
Mueller, Mira [1 ]
Ernst, Susanne [5 ]
Ballarino, Paola [6 ]
Alafify, Azza A. [7 ]
Zellweger, Christa [1 ]
Wildi, Karin [1 ]
Moehring, Berit [1 ]
Vilaplana, Carles [8 ]
Bernhard, Denise [1 ]
Merk, Salome [1 ]
Ebmeyer, Stefan [9 ]
Freidank, Heike [10 ]
Osswald, Stefan [1 ]
Mueller, Christian [1 ]
机构
[1] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland
[2] Univ Paris 13, Avicenne Hosp, Bobigny, France
[3] Paris Descartes Univ, Cochin Hosp, AP HP, Dept Cardiol, Paris, France
[4] Univ Herzzentrum Freiburg, Bad Krozingen, Germany
[5] Kantonsspital Olten, Dept Internal Med, Olten, Switzerland
[6] San Martino Hosp, Emergency Dept, Genoa, Italy
[7] King Saud Med City, Dept Cardiol, Riyadh, Saudi Arabia
[8] Hosp Mar IMIM, Lab Serv, Barcelona, Spain
[9] BRAHMS, Thermo Fisher Sci, Res Dept, Hennigsdorf, Germany
[10] Univ Basel Hosp, Lab Med, CH-4031 Basel, Switzerland
关键词
UNIVERSAL DEFINITION; GENDER-DIFFERENCES; MANAGEMENT; MORTALITY; SEX; ASSOCIATION; RISK; AGE;
D O I
10.1016/j.ahj.2013.03.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Concerns have been raised about possible gender disparities in cardiac investigations and/or outcome. This study sought to examine and compare 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. Results Of 1,247 patients, 420 were women and 827 were men. Although the rate of acute myocardial infarction was similar in women (14.5%) and men (16.6%, P =.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 =.002) than men. Diagnostic accuracy as quantified by the area under the receiver operating characteristic curve (AUC) for acute myocardial infarction in women was 0.90 (95% 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 =.008, P =.006, and P =.002, respectively). Prognostic accuracy as quantified by the AUCs for 1-year mortality was 0.69 (0.56-0.83), 0.86 (0.79-0.93), 0.87 (0.81-0.94), and 0.87 (0.80-0.94), respectively. No relevant gender differences in AUCs were observed. Conclusion The diagnostic and prognostic performance of cTnT, hs-cTnT, and copeptin is as good in women as in men. High-sensitivity cTnT and the combination of cTnT and copeptin outperform cTnT alone, both in women and men.
引用
收藏
页码:30 / 37
页数:8
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