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Review
. 2017 May;19(5):40.
doi: 10.1007/s11886-017-0839-9.

Cardiac Biomarkers and the Diagnosis of Myocardial Infarction in Women

Anoop S V Shah  1 , Amy V Ferry  2 , Nicholas L Mills  2
Affiliations
Review

Cardiac Biomarkers and the Diagnosis of Myocardial Infarction in Women

Anoop S V Shah et al. Curr Cardiol Rep. 2017 May.

Abstract

Purpose of review: Women with suspected acute coronary syndrome are less likely to undergo investigation or receive treatment than men, and women consistently have poorer outcomes. This review summarises how the latest development in cardiac biomarkers could improve both diagnosis and outcomes in women.

Recent findings: Novel high-sensitivity cardiac troponin assays have identified differences in the reference range and therefore diagnostic threshold for myocardial infarction in men and women. These differences are present across multiple populations with different ethnic backgrounds and for a range of assays. The use of a uniform threshold for cardiac troponin does not provide equivalent prediction in men and women, with lower thresholds needed for women to provide comparable risk stratification. Sex differences in cardiac troponin concentrations are not widely recognised in clinical practice and may be contributing to the under-diagnosis of myocardial infarction in women and discrepancies in patient care and outcomes.

Keywords: Biomarkers; Cardiac troponin; Myocardial infarction; Sex.

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Conflict of interest statement

Conflict of Interest

Anoop S.V. Shah has received honoraria from Abbott Diagnostics. Amy V. Ferry declares that she has no conflict of interest. Nicholas L. Mills has consulted and received research grants from Abbott Diagnostics and has consulted for Roche Diagnostics and Singulex.

Human and Animal Rights and Informed Consent

All studies included in this review were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Figures

Fig. 1
Fig. 1
Risk of mortality in women compared to men in randomised control trials before and after adjustment for age (a) and stratified by age in a large cohort study (b). TIMI II Thrombolysis in myocardial infarction II [6], GUSTO Global Utilization of t-PA and Streptokinase for Occluded Coronary Arteries (GUSTO-I) trial [7], TAMI Thrombolysis and Angioplasty in Myocardial Infarction [8], ISIS-3 Third International Study of Infarct Survival [9]
Fig. 2
Fig. 2
Proposed biological explanations for differences in the distribution of cardiac troponin in men and women
See this image and copyright information in PMC

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