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Prognostic Importance of Sex-Specific Cardiac Troponin T 99(th) Percentiles in Suspected Acute Coronary Syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Bertil Lindahl)
Karolinska Univ Hosp, Karolinska Inst, Cardiol Sect, Dept Med, Huddinge, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
2016 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 129, no 8, 880.e1Article in journal (Refereed) Published
Abstract [en]


Cardiac troponin levels differ between the sexes, with higher values commonly seen in men. The use of sex-specific troponin thresholds is, thus, subject of an ongoing debate. We assessed whether sex-specific cardiac troponin T (cTnT) 99th percentiles would improve risk prediction in patients admitted to Swedish coronary care units due to suspected acute coronary syndrome.


In this retrospective register-based study (48,250 patients), we investigated the prediction of all-cause mortality and the composite of cardiovascular death or nonfatal myocardial infarction within 1 year using the single 99th cTnT percentile (>14 ng/L) or sex-specific cTnT 99th percentiles (>16/9 ng/L).


A total of 1078 men (3.0%) with cTnT 15-16 ng/L and 1854 women (8.4%) with cTnT 10-14 ng/L would have been reclassified regarding their cTnT status by the means of sex-specific 99th percentiles. The prevalence of cardiovascular risk factors and crude event rates increased across higher cTnT strata in both men and women. Multivariable-adjusted Cox models, however, did not demonstrate better risk prediction by sex-specific 99th percentiles. Assessing cTnT as a continuous variable demonstrated an increase in multivariable-adjusted risk starting at levels around 10-12 ng/L in both men and women.


We found no evidence supporting the use of sex-specific cTnT 99th percentiles in men and women admitted because of suspected acute coronary syndrome. This likely depends on sex-specific differences in disease mechanisms associated with small cTnT elevations. From a pragmatic perspective, a single cTnT cutoff slightly below 14 ng/L seems to be preferable as a threshold for medical decision-making.

Place, publisher, year, edition, pages
2016. Vol. 129, no 8, 880.e1
Keyword [en]
Acute coronary syndrome; Cardiac troponin; Cutoff; Risk prediction; Sex
National Category
Cardiac and Cardiovascular Systems
Research subject
URN: urn:nbn:se:uu:diva-307337DOI: 10.1016/j.amjmed.2016.02.047ISI: 000380253000048PubMedID: 27059383OAI: oai:DiVA.org:uu-307337DiVA: diva2:1046221
Swedish Foundation for Strategic Research
Available from: 2016-11-12 Created: 2016-11-12 Last updated: 2016-11-24Bibliographically approved

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