ArticleInternal and emergency medicine2026
Circadian troponin dynamics reveal sex-specific signals for acute coronary syndrome evaluation.
Article in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
High-sensitivity cardiac troponin (hs-cTn) exhibits circadian variation, yet whether these variations differ by sex and influence early risk stratification for suspected acute coronary syndrome (ACS) is uncertain. We performed a secondary analysis of the RACE-IT stepped-wedge randomized trial across nine Michigan emergency departments (July 2020-April 2021). From the 32,609 patients in the primary trial, we analyzed those with available hs-cTnI values, time-stamped, that fell within the indeterminate range (4-18 ng/L) and were performed with the Beckman Coulter assay. We performed cosinor regression models to evaluate diurnal variation and multivariable logistic regression to analyze the association with 30-day major adverse cardiac events (MACE) after adjusting for cardiovascular risk factors. Median age was 57 years; 42% were men. Men showed a higher Midline Estimating Statistic of Rhythm (MESOR) hs-cTnI (6.3 ng/L vs 5.5 ng/L; p < 0.001) and greater diurnal amplitude (β = 0.21 vs 0.13; p < 0.001). Peak concentrations occurred at 6:06 AM in both sexes. In multivariable analysis, male sex (adjusted odds ratio [aOR] 2.37, 95% CI 1.68-3.34) and earlier presentation time (per 6-h interval closer to midnight: aOR 0.65, 95% CI 0.54-0.79) independently predicted 30-day MACE. Each 1 ng/L increase in hs-cTnI conferred a 7% higher MACE risk (OR 1.07, 95% CI 1.03-1.12). hs-cTnI exhibits sex-specific circadian patterns with independent prognostic significance. These findings support the potential for time- and sex-adjusted hs-cTnI thresholds to improve early risk stratification in emergency care.
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