Extract

Sex-specific reference intervals for cardiac troponin exist, with the 99th percentile (the cutpoint for determination of an increased troponin) being substantially lower in females than males (1, 2). Although recent guidelines have recommended their use (3, 4), clinical utilization of sex-specific ranges is limited. Troponin is engrained in our assessment of risk, diagnosis of disease, treatment options, and determination of prognosis (5). Irrespective of sex, the risk of acute myocardial infarction (AMI),3 cardiovascular death, recurrent MI, refractory ischemia, and rehospitalization increases with increasing troponin concentrations. The finding of an increased troponin often leads to targeted medical interventions designed to improve outcomes. The definition of an increased troponin is critical; if the cutpoint is set too high, there is the potential for missed diagnoses, leading to fewer receiving guideline-recommended management, and poorer outcomes. Currently women with acute coronary syndromes (ACS) receive less guideline-recommended treatment and have worse outcomes than men (6).

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