Sex-specific effects of implementing a high-sensitivity troponin I assay in patients with suspected acute coronary syndrome: results from SWEDEHEART registry
Sex-specific effects of implementing a high-sensitivity troponin I assay in patients with suspected acute coronary syndrome: results from SWEDEHEART registry
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DOI：
10.1038/s41598-020-72204-2
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发表时间：
2020-09-17
影响因子：
4.6
通讯作者：
Eggers, Kai M.
中科院分区：
文献类型：
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作者：
Kimenai, Dorien M.;Lindahl, Bertil;Eggers, Kai M.
使用高灵敏度心肌肌钙蛋白（hs-cTn）检测与性别特异性第99次重复测定可能会改善疑似急性心肌梗死（AMI）患者的管理。我们研究了从传统肌钙蛋白I检测转换为具有性别特异性阈值的高灵敏度检测对入住瑞典冠心病监护室的疑似急性冠脉综合征患者的影响。基于SWEDEHEART登记研究的数据（女性，n= 4，819/男性，n= 7，670），我们使用性别特异性第99次血清学试验比较了实施hs-cTnI检测（Abbott）前后的时间段。我们调查了出院诊断、住院检查、治疗和临床结果的差异。在实施hs-cTnI检测后，女性和男性肌钙蛋白水平高于诊断AMI阈值的患者比例分别增加了24.3%和14.8%。AMI的发生率分别增加了11.5%和9.8%。无论性别，诊断干预和治疗都有所增加。然而，这些协会没有坚持多变量调整后，可能是由于在观察期间的时间管理趋势的影响。总体而言，未观察到重大心血管不良事件的风险降低（HR：0.91 [95% CI 0.80-1.03]，P=0.126）。hs-cTnI检测联合性别特异性第99次重复检测与AMI发病率增加相关，与性别无关，但对临床管理和预后无重大影响。
Using high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific 99th percentiles may improve management of patients with suspected acute myocardial infarction (AMI). We investigated the impact of transitioning from a conventional troponin I assay to a high-sensitivity assay with sex-specific thresholds, in patients with suspected acute coronary syndrome admitted to Swedish coronary care units. Based on data from SWEDEHEART registry (females, n=4,819/males, n=7,670), we compared periods before and after implementation of hs-cTnI assay (Abbott) using sex-specific 99th percentiles. We investigated differences on discharge diagnosis, in-hospital examinations, treatments, and clinical outcome. Upon implementation of the hs-cTnI assay, proportion of patients with troponin levels above diagnostic AMI threshold increased in women and men by 24.3% versus 14.8%, respectively. Similarly, incidence of AMI increased by 11.5% and 9.8%. Diagnostic interventions and treatments increased regardless of sex. However, these associations did not persist following multivariable adjustment, probably due to the effect of temporal management trends during the observation period. Overall, no risk reduction on major adverse cardiovascular events was observed (HR: 0.91 [95% CI 0.80-1.03], P=0.126). The implementation of hs-cTnI assay together with sex-specific 99th percentiles was associated with an increase in incidence of AMI regardless of sex, but had no major impact on clinical management and prognosis.