Sex Differences in Cardiac Troponin Testing in Patients Presenting to the Emergency Department with Chest Pain.

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  • Additional Information
    • Source:
      Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 101159262 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-843X (Electronic) Linking ISSN: 15409996 NLM ISO Abbreviation: J Womens Health (Larchmt) Subsets: MEDLINE
    • Publication Information:
      Original Publication: Larchmont, NY : Mary Ann Liebert, Inc., [2002]-
    • Subject Terms:
      Chest Pain*/blood ; Chest Pain*/diagnosis ; Chest Pain*/epidemiology; Angina Pectoris/*diagnosis ; Myocardial Infarction/*diagnosis ; Troponin/*blood; Adult ; Angina Pectoris/epidemiology ; Canada/epidemiology ; Cardiac Catheterization/methods ; Cardiac Catheterization/statistics & numerical data ; Electrocardiography/methods ; Electrocardiography/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Sex Factors ; Triage/methods ; Triage/statistics & numerical data
    • Abstract:
      Background: Elevated cardiac troponin (cTn), with signs/symptoms of ischemia, is a key element in a diagnosis of myocardial infarction (MI). Underdiagnosis of MI in women has been attributed to atypical symptoms, inconsistent ECG findings, and less diagnostic testing. We sought to determine if there are sex differences in cTn testing following presentation to the emergency department (ED) with a chief complaint of ischemic chest pain (CP) and if presentation affects diagnostic assessment.
      Methods: All adults presenting to six hospital EDs in the Vancouver, Canada with a chief complaint of ischemic CP from 2009 to 2013 were included. The highest cTn level within 24 hours of ED presentation was used. CP was classified into cardiac- or respiratory dominant based on standard Canadian Emergency Department Triage and Acuity Scale coding. Chi-square testing was used to test for sex differences in CP categories and cTn testing within 24 hours. Logistic regression models were used to examine the association between sex, cTn testing, and CP categories.
      Results: Of 27,063 patients with ischemic CP, cardiac presentation was more common in men than women, irrespective of age. Among cardiac CP, 24.7% of men were <50 years compared to 18.2% of women; however, more women (19.9%) than men (11.6%) were >80 years. Overall, women were 1.8% less likely to have cTn testing; in patients <50 years, testing was markedly lower in women compared to men [odds ratio, OR (95% confidence intervals, CI) 0.78 (0.70-0.87)]. The odds of cardiac catheterization within 90 days of ED presentation were lower in women [OR, (95% CI) 0.52 (0.44-0.63)]. Even with cardiac CP, 17.7% of women versus 32.7% of men had cardiac catheterization.
      Conclusions: In men and women presenting to the ED with ischemic CP, cTn testing overall is similar except among young women under 50 years old, where it is markedly lower. Women undergo less cardiac catheterization, irrespective of CP type.
    • Comments:
      Comment in: J Womens Health (Larchmt). 2018 Nov;27(11):1305-1306. (PMID: 30256703)
    • Grant Information:
      Canada CIHR
    • Contributed Indexing:
      Keywords: cardiac catheterization; cardiac troponin; sex differences
    • Accession Number:
      0 (Troponin)
    • Publication Date:
      Date Created: 20180717 Date Completed: 20191115 Latest Revision: 20191115
    • Publication Date:
      20231215
    • Accession Number:
      10.1089/jwh.2017.6812
    • Accession Number:
      30010472