Trial reportJournal of the American College of Cardiology2019
Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome.
Trial report in Journal of the American College of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 59 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome: A Randomized Controlled Trial
Trial of Switching High-sensitivity Cardiac Troponin Assays in Suspected Acute Coronary Syndrome: an Interrupted Time Series Analysis (TWITCH-ED Study)
Who cites it
59 citing papers in PubMed, 3 syntheses or guidelines pooled it, 124 citations in OpenAlex.
- Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis.Current cardiology reviews · 2023Pooled it
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Sex-Specific Associations of Cardiovascular Risk Factors and Biomarkers With Incident Heart Failure.Journal of the American College of Cardiology · 2020Pooled it
- Validation of the myocardial-ischaemic-injury-index machine learning algorithm to guide the diagnosis of myocardial infarction in a heterogenous population: a prespecified exploratory analysis.The Lancet. Digital health · 2022Trial
- Redesigning cardiovascular medicine around sex differences.Nature medicine · 2026Review
- HEART Score Distribution and Association with In-Hospital Management and Outcomes in COVID-19 Survivors Presenting with Acute Chest Pain.Journal of clinical medicine · 2026Article
- Contemporary Management of Acute Coronary Syndromes in the Cardiac Intensive Care Unit: From Rapid Diagnosis to Early Secondary Prevention.Journal of cardiovascular development and disease · 2026Review
- Coronary Artery Disease in Women: Sex-Specific Pathophysiology, Risk Factors, Clinical Presentation and Management.Medicina (Kaunas, Lithuania) · 2026Review
- Sex differences in acute chest pain care in a multisite U.S. emergency department cohort.The American journal of emergency medicine · 2026Observational
- Machine learning for diagnosing non-ST-segment elevation myocardial infarction: a derivation and validation study.EClinicalMedicine · 2026Article
- Sex representation in trials relative to indication-specific disease burden in FDA-approved drugs (2015-2023).Nature communications · 2026Article
- Circulating CD38 shows stronger association with incident heart failure in women despite lower levels: sex differences and kidney-function context.Biology of sex differences · 2026Article
- Sex-Consistent Performance of an AI-Enabled ECG for Acute Myocardial Infarction: The ROMIAE Study.JACC. Advances · 2026Article
- Evolving Insights Regarding Biomarkers to Better Manage Older Adults With Cardiovascular Disease.The journal of applied laboratory medicine · 2025Review
- Article
- Using higher cut-off values to diagnose acute myocardial infarction in patients with elevated hs-cTnT.Journal of biomedical research · 2025Article
- Harnessing Artificial Intelligence for Innovation in Interventional Cardiovascular Care.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Review
- Are sex and gender dimensions accounted for in NICE guidelines? A systematic review of 223 clinical guidelines.BMJ public health · 2025Article
- The impact of obesity, age, and gender on plasmatic levels of selected glycoprotein biomarkers and miRNA-499 in OSA patients.Journal of applied biomedicine · 2024Article
- Sex differences in the management of patients with suspected acute coronary syndrome in China.Internal and emergency medicine · 2024Article
Corrections and comments
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Authors and funding
24 authors at 12 institutions in 3 countries.
Funding
Abstract
backgroundMajor disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized.
objectivesThe aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome.
methodsConsecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury was defined as high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/l in women and 34 ng/l in men. The primary outcome was recurrent myocardial infarction or cardiovascular death at 1 year.
resultsA total of 48,282 patients (47% women) were included. Use of the high-sensitivity cardiac troponin I assay with sex-specific thresholds increased myocardial injury in women by 42% and in men by 6%. Following implementation, women with myocardial injury remained less likely than men to undergo coronary revascularization (15% vs. 34%) and to receive dual antiplatelet (26% vs. 43%), statin (16% vs. 26%), or other preventive therapies (p < 0.001 for all). The primary outcome occurred in 18% (369 of 2,072) and 17% (488 of 2,919) of women with myocardial injury before and after implementation, respectively (adjusted hazard ratio: 1.11; 95% confidence interval: 0.92 to 1.33), compared with 18% (370 of 2,044) and 15% (513 of 3,325) of men (adjusted hazard ratio: 0.85; 95% confidence interval: 0.71 to 1.01).
conclusionsUse of sex-specific thresholds identified 5 times more additional women than men with myocardial injury. Despite this increase, women received approximately one-half the number of treatments for coronary artery disease as men, and outcomes were not improved. (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]; NCT01852123).
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.