Are Conventional Troponin Assays Leading to Underdiagnosis of MI in Women?

Most hospitals use a single standard for an abnormal troponin level, but using sex-specific thresholds may be more appropriate. Researchers in Scotland evaluated consecutive patients with an acute coronary syndrome to determine the effect of applying sex-specific diagnostic thresholds to results of a high-sensitivity assay for cardiac troponin I compared with a single threshold based on a conventional troponin I test.

Of the 1126 patients (504 women and 622 men), 11% of the women and 19% of the men were classified as having a type 1 myocardial infarction (MI) based on the standard troponin I assay. Using the high-sensitivity assay and sex-specific thresholds, 22% of the women and 21% of the men were classified as having a type 1 myocardial infarction. At 12 months, outcomes of women identified solely with the high-sensitivity troponin I assay and sex-specific thresholds were similar to those who met criteria for type 1 MI with the conventional assay. For men with MI identified solely by the sex-specific threshold, risk was higher compared with both men without myocardial infarction and men with MI identified by the conventional assay.