Table 3: Studies reporting performance and prognostic impact of sex-specific cut-offs in different populations. MACE: major adverse cardiovascular events; MI: myocardial infarction.

StudyYearPatientsWomen (%)Cut-off applied (ng/L)Comments

hs-cTnT (Roche Diagnostics)

Mueller-Hennessen et al. [92]20161282477 (37%)15.59.0Sex-specific cut-offs increased MI diagnosis in women (from 17% to 23%) but this did not affect outcomes

15.59.0Reclassification occurred in only 3 patients; no effects on outcomes. Tested three different sets of sex-specific cut-offs
Rubini Gimenez et al. [91]20162734876 (32%)17.09.0

16.09.0Using sex-specific cut-offs, the prevalence of MI would increase by 3.3% in women. Sex-specific cut-offs did not improve risk prediction, but the study identified an increase of risk in women starting at 10-12 ng/L instead of 14 ng/L.
Eggers et al. [93]20165755622027 (38%)26.015.0

Mueller et al. [99]201835881643 (46%)169Sex-specific cut-offs increased myocardial injury diagnosis in 11% of women compared to a 4% decrease in men

McRae et al. [94]201871303199 (45%)Several combinations according to sexImplementation of sex-specific cut-offs improved specificity of hs-cTnT in the diagnostic approach of ACS

Yang et al. [95]2016812376 (46%)Several according to age and sexSex-specific cut-offs were calculated in a healthy Chinese cohort and further stratified for age

hs-cTnI (Abbott Diagnostics)

Shah et al. [96]20184828222562 (47%)3416Sex-specific cut-offs for an hs-cTnI assay, compared to a contemporary cTnI assay, led to a two-fold myocardial injury reclassification rate in women; no difference in 1-year outcomes among reclassified patients treated according to cTnI vs hs-cTnI levels

Shah et al. [98]20151126504 (45%)3416Sex-specific cut-offs increase MI diagnosis in women (from 16 to 22%) while having small effects on men

Mueller et al. [99]201835881643 (46%)3416Sex-specific cut-offs increased myocardial injury diagnosis in 6% of women compared to a 3% decrease in men

Cullen et al. [97]201628411180 (41%)3416Small amount of women and men reclassified using sex-specific thresholds, thus improving identification of women at long-term (1 year) risk for MACE

Eggers et al. [100]201427501073 (39%)24.816.6Sex-specific cut-offs were derived from a reference population recruited for the purposes of the study. Sex-specific cut-offs did not show improvement in the identification of more at-risk patients; however higher concentrations of troponins show stronger predictive value in women than men

Bohula May et al. [101]201446951460 (31%)3416Population presenting with typical ischemic symptoms. Using sex-specific thresholds, only 6 patients were reclassified; no improvement in prognostic performance.