Cao Mengchen, Pierce Ava E, Norman Marquita S, Thakur Bhaskar, Diercks Kiersten, Hale Cooper, Issioui Yacine, Diercks Deborah B
Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas.
Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas.
Clin Ther. 2024 Dec;46(12):988-994. doi: 10.1016/j.clinthera.2024.09.025. Epub 2024 Nov 5.
High-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) have been demonstrated to have lower sex-specific 99th percentiles in healthy females. However, these sex-specific thresholds are not widely adopted in clinical practice which could lead to underdiagnosis of acute myocardial infarction in females. We conducted a systematic review to explore sex-specific 99th percentiles for hs-cTnI and hs-cTnT from healthy reference populations.
The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to complete this systematic review. We used PubMed and OVID EMBASE to search for original studies published between November 2017 and November 2021 that included reference populations used to establish the 99th percentiles of hs-cTnI and hs-cTnT with the following inclusion criteria: adults; English language; samples taken as part of a healthy, reference population; studies using high-sensitivity troponin assay; and sample size > 300. Studies were excluded if the reference population sample size was < 300, if a conventional troponin assay was used, or if they did not include independently derived, sex-specific 99th percentiles. Data was extracted from the studies through Covidence to perform a qualitative data synthesis. Female-specific, male-specific, and overall 99th percentiles for hs-cTn were compared.
We reviewed 131 articles of which 19 met inclusion criteria. These 19 studies derived sex-specific 99th percentiles for 11 different hs-cTnI assays and 9 different hs-cTnT assays. More than 90% (13 of 14 studies) of hs-cTnI assays found lower female 99th percentiles compared to male and to overall 99th percentiles. One study included nine different hs-cTnI assays, of which only one assay resulted in a higher female 99th percentile compared to male and to overall 99th percentiles. Eight of nine hs-cTnT studies (88.9%) found lower female 99th percentiles compared to male and to overall 99th percentiles.
The data shows significantly lower 99th percentiles in females compared to 99th percentiles in males and overall. Incorporating these sex-specific 99th percentile cut-offs into clinical practice could lead to increased diagnosis and potentially better outcomes for females presenting with acute myocardial infarction.
高敏心肌肌钙蛋白I（hs-cTnI）和T（hs-cTnT）在健康女性中的性别特异性第99百分位数较低。然而，这些性别特异性阈值在临床实践中并未广泛采用，这可能导致女性急性心肌梗死的诊断不足。我们进行了一项系统评价，以探索来自健康参考人群的hs-cTnI和hs-cTnT的性别特异性第99百分位数。
采用系统评价和Meta分析的首选报告项目（PRISMA）指南的原则来完成这项系统评价。我们使用PubMed和OVID EMBASE搜索2017年11月至2021年11月期间发表的原始研究，这些研究包括用于确定hs-cTnI和hs-cTnT第99百分位数的参考人群，纳入标准如下：成年人；英语；作为健康参考人群的一部分采集的样本；使用高敏肌钙蛋白检测的研究；样本量>300。如果参考人群样本量<300、使用传统肌钙蛋白检测或未包括独立得出的性别特异性第99百分位数，则排除这些研究。通过Covidence从研究中提取数据，以进行定性数据综合。比较了hs-cTn的女性特异性、男性特异性和总体第99百分位数。
我们审查了131篇文章，其中19篇符合纳入标准。这19项研究得出了11种不同hs-cTnI检测和9种不同hs-cTnT检测的性别特异性第99百分位数。超过90%（14项研究中的13项）的hs-cTnI检测发现女性第99百分位数低于男性和总体第99百分位数。一项研究包括9种不同的hs-cTnI检测，其中只有一种检测的女性第99百分位数高于男性和总体第99百分位数。9项hs-cTnT研究中的8项（88.9%）发现女性第99百分位数低于男性和总体第99百分位数。
数据显示，女性的第99百分位数明显低于男性和总体第99百分位数。将这些性别特异性第99百分位数临界值纳入临床实践可能会增加对患有急性心肌梗死女性的诊断，并可能带来更好的结果。
