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Cardiovascular Therapeutics
Volume 2019, Article ID 9546931, 12 pages
Review Article

Sex-Specific Cut-Offs for High-Sensitivity Cardiac Troponin: Is Less More?

1Department of Internal Medicine and Medical Specialties, Sapienza–University of Rome, Rome, Italy
2Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
3Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
4Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza–University of Rome, Rome, Italy
5Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
6Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
7Department of Experimental Medicine, Sapienza–University of Rome, Rome, Italy
8Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada

Correspondence should be addressed to Stefania Basili; ti.1amorinu@ilisab.ainafets

Received 14 October 2018; Revised 8 January 2019; Accepted 16 January 2019; Published 5 February 2019

Academic Editor: Nicholas B. Norgard

Copyright © 2019 Giulio Francesco Romiti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Management of patients presenting to the Emergency Department with chest pain is continuously evolving. In the setting of acute coronary syndrome, the availability of high-sensitivity cardiac troponin assays (hs-cTn) has allowed for the development of algorithms aimed at rapidly assessing the risk of an ongoing myocardial infarction. However, concerns were raised about the massive application of such a simplified approach to heterogeneous real-world populations. As a result, there is a potential risk of underdiagnosis in several clusters of patients, including women, for whom a lower threshold for hs-cTn was suggested to be more appropriate. Implementation in clinical practice of sex-tailored cut-off values for hs-cTn represents a hot topic due to the need to reduce inequality and improve diagnostic performance in females. The aim of this review is to summarize current evidence on sex-specific cut-off values of hs-cTn and their application and usefulness in clinical practice. We also offer an extensive overview of thresholds reported in literature and of the mechanisms underlying such differences among sexes, suggesting possible explanations about debated issues.