Gender-specific biomarker thresholds urged in MI diagnosis

The under-recognition of heart disease and differences in clinical presentation in women lead to less aggressive treatment strategies and a lower representation of women in clinical trials. Thus, as seen in this study, an improvement in the diagnosis of MI in women using the more sensitive cardiac troponin assay and different gender-based cutoffs can have a meaningful impact in outcomes in our female patients.

Dr. Hiren Shah

In a recent large meta-analysis of 11 randomized ACS trials it was shown that sex-based differences in 30-day mortality among patients with various manifestations of ACS are largely explained by clinical differences at presentation and the severity of angiographically documented disease (JAMA. 2009;302:874-82.). Thus, new assays that account for gender-based differences may lead to an earlier identification of heart disease in women to address some component of this mortality disparity.

The second phase of this study using these new thresholds will shed light on if this increased capture rate of MI for women leads to improved long term cardiac outcomes, as one hopes that the increased sensitivity seen in the first phase of the study is also balanced with an improvement in specificity. If the results of this and future studies are conclusive, gender-based interpretation of diagnostic tests will lead to earlier diagnosis and improved therapeutic strategies in women.

Dr. Hiren Shah is an assistant professor of medicine in the Feinberg School of Medicine, Northwestern University, Chicago, and a medical director of the Medicine and Cardiac Telemetry Hospitalist Unit at Northwestern Memorial Hospital in Chicago. He is on the advisory board of Hospitalist News.