![]() ![]() Study-specific analyses for the MyRiAD study were described previously they included the levels of myeloid-related protein 8/14 (MRP 8/14), heart-type fatty acid-binding protein (H-FABP), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), myeloperoxidase (MPO), pregnancy-associated plasma protein A (PAPP-A), insulin-like growth factor 1 (IGF-1), fibrinogen and high-sensitivity cardiac troponin (hs-cTnT). D-dimers were determined from citrate plasma (Roche Modular Analytics System, Roche Diagnostics, Rotkreuz, Switzerland). The cut-off value for positive c-cTnT measurements was 0.10 µg/l. In brief, routine markers including c-cTnT, myoglobin, CK, CK-MB and NT-proBNP were analyzed from heparin plasma with a maximal inter-assay variation of 3.7, 2.5, 1.8, 2.8 and 4.4%, and a detection limit of 10.0 ng/l, 21.0 µg/l, 7.0 U/l, 3.0 U/l and 5.0 ng/l, respectively. Laboratory analyses were performed as previously described. Written informed consent to participate was obtained from all patients. The study was conducted according to the principles of the Declaration of Helsinki, and approval to conduct the study was granted by the institutional ethics committee of the University Hospital Zurich. Of 538 patients screened, 377 (70%) were included in the final analyses. Exclusion criteria were symptom onset >24 h, any trauma and any acute or chronic infection. Inclusion criteria were any signs or symptoms suggestive of ACS including chest pain, epigastric pain, dyspnoea, hypotension, lightheadedness, cardiac arrest, palpitations, syncope and nausea as well as a consecutive request by the emergency physician to perform a troponin test to confirm or rule out myocardial ischaemia. In the single-centre, prospective, observational MyRiAD (Myeloid Related Protein 8/14 in the Evaluation of Acute Chest Pain in the Emergency Department) study, consecutive patients who presented to the emergency department with any signs and symptoms suggestive of ACS and for whom conventional troponin T (c-cTnT) measurements were requested on clinical grounds, were included from July 2007 to April 2008. ![]() ![]() A more thorough characterization of this patient population may expand our understanding of gender-related differences in clinical presentation, and thereby improve patient triage and management in emergency care. In the heterogeneous patient population presenting with suspected ACS, gender-related disparities in clinical characteristics, biomarker profiles and underlying diagnoses have not yet been fully elucidated. Furthermore, information on final diagnoses and the proportion of patients undergoing urgent coronary angiography is often lacking. Data on gender-related differences, however, are mainly based on the ACS patient population, and studies on unselected patients presenting to the emergency department with any signs and symptoms suggestive of ACS are scare, and have mostly been obtained in primary care or were restricted to chest pain syndromes. In ACS patients, gender-related differences in presentation and outcomes have previously been reported, and besides observed disparities in baseline characteristics, associations between atypical symptoms including back pain, nausea and shortness of breath and female gender were identified. Conclusions: In patients with suspected ACS, women presented with different biomarker profiles, and were less often diagnosed with ACS and referred to coronary angiography. In multivariate analysis, female gender was associated with a lower referral for coronary angiography (HR 0.41, 95% CI 0.23-0.78, p = 0.006). 51%), and were not referred for urgent coronary angiography as often as men (p < 0.001). Women were less frequently diagnosed with ACS (30 vs. c-cTnT was positive in 8% of female and in 14% of male patients (p = 0.16), TIMI risk score and cardiac biomarkers including c-cTnT, hs-cTnT, myoglobin, creatine kinase, N-terminal pro-brain natriuretic peptide, myeloid-related protein 8/14 and pregnancy-associated plasma protein A were lower in women (p < 0.05). Results: Women were older than men (p = 0.004), and had a lower prevalence of known coronary artery and peripheral vascular disease (p < 0.05). Suspected ACS was defined as a request for conventional troponin T (c-cTnT) measurements on clinical grounds. Methods: This single-centre, prospective cohort study included 377 consecutive patients presenting with suspected ACS to the emergency department. The aim of this study was to assess gender-related disparities in clinical profiles, biomarkers and diagnoses of patients with suspected ACS. Objectives: Gender differences in patients presenting with suspected acute coronary syndromes (ACS) have not yet been fully characterized. ![]()
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