دورية أكاديمية
Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome.
| العنوان: | Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome. |
|---|---|
| المؤلفون: | Lee, KK, Ferry, AV, Anand, A, Strachan, FE, Chapman, AR, Kimenai, DM, Meex, SJR, Berry, C, Findlay, I, Reid, A, Cruickshank, A, Gray, A, Collinson, PO, Apple, FS, McAllister, DA, Maguire, D, Fox, KAA, Newby, DE, Tuck, C, Keerie, C, Weir, CJ, Shah, ASV, Mills, NL, High-STEACS Investigators |
| بيانات النشر: | Elsevier |
| سنة النشر: | 2019 |
| المجموعة: | St George's University of London: Repository |
| الوصف: | BACKGROUND: Major disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized. OBJECTIVES: The aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome. METHODS: Consecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury was defined as high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/l in women and 34 ng/l in men. The primary outcome was recurrent myocardial infarction or cardiovascular death at 1 year. RESULTS: A total of 48,282 patients (47% women) were included. Use of the high-sensitivity cardiac troponin I assay with sex-specific thresholds increased myocardial injury in women by 42% and in men by 6%. Following implementation, women with myocardial injury remained less likely than men to undergo coronary revascularization (15% vs. 34%) and to receive dual antiplatelet (26% vs. 43%), statin (16% vs. 26%), or other preventive therapies (p < 0.001 for all). The primary outcome occurred in 18% (369 of 2,072) and 17% (488 of 2,919) of women with myocardial injury before and after implementation, respectively (adjusted hazard ratio: 1.11; 95% confidence interval: 0.92 to 1.33), compared with 18% (370 of 2,044) and 15% (513 of 3,325) of men (adjusted hazard ratio: 0.85; 95% confidence interval: 0.71 to 1.01). CONCLUSIONS: Use of sex-specific thresholds identified 5 times more additional women than men with myocardial injury. Despite this increase, women received approximately one-half the number of treatments for coronary artery disease as men, and outcomes were not improved. (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]; NCT01852123). |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| العلاقة: | https://openaccess.sgul.ac.uk/id/eprint/111346/1/1-s2.0-S073510971937370X-main.pdfTest; Lee, KK; Ferry, AV; Anand, A; Strachan, FE; Chapman, AR; Kimenai, DM; Meex, SJR; Berry, C; Findlay, I; Reid, A; et al. Lee, KK; Ferry, AV; Anand, A; Strachan, FE; Chapman, AR; Kimenai, DM; Meex, SJR; Berry, C; Findlay, I; Reid, A; Cruickshank, A; Gray, A; Collinson, PO; Apple, FS; McAllister, DA; Maguire, D; Fox, KAA; Newby, DE; Tuck, C; Keerie, C; Weir, CJ; Shah, ASV; Mills, NL; High-STEACS Investigators (2019) Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome. J Am Coll Cardiol, 74 (16). pp. 2032-2043. ISSN 1558-3597 https://doi.org/10.1016/j.jacc.2019.07.082Test SGUL Authors: Collinson, Paul |
| الإتاحة: | https://doi.org/10.1016/j.jacc.2019.07.082Test https://openaccess.sgul.ac.uk/id/eprint/111346Test/ https://openaccess.sgul.ac.uk/id/eprint/111346/1/1-s2.0-S073510971937370X-main.pdfTest |
| حقوق: | cc_by_4 |
| رقم الانضمام: | edsbas.EAD1906E |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |