ACS Troponin Interpretation Aid Sex Specific Thresholds Calculator

ACS Troponin Interpretation Aid Sex Specific Thresholds Explanation and Clinical Context This tool supports interpretation of high sensitivity cardiac troponin concentrations in patients with suspected acute coronary syndrome by relating the measured value to the appropriate sex specific ninety ninth percentile upper reference limit reported for the local assay. Current guidelines recommend high sensitivity troponin as the preferred biomarker for myocardial injury and define myocardial infarction as a pattern of rising or falling troponin with at least one value above the assay specific ninety ninth percentile upper reference limit in the presence of clinical evidence of ischemia. Women have lower normal troponin concentrations than men and use of a single combined threshold can lead to missed myocardial infarction in women therefore use of validated sex specific reference limits is encouraged when available and supported by local laboratory practice.

This calculator does not embed a fixed decision algorithm or delta cutpoint because these thresholds are assay specific and may differ between laboratories instead it makes transparent how far the observed concentration sits above or below the sex specific ninety ninth percentile and reports this as a multiple of that limit. Interpretation of any troponin result must always be integrated with timing of symptom onset serial troponin testing electrocardiographic changes imaging findings and overall clinical risk assessment and this aid should never be used in isolation to exclude or confirm myocardial infarction. Reference Rao SV et al.

Twenty twenty five guideline for the management of patients with acute coronary syndromes Journal of the American College of Cardiology volume eighty five pages two thousand one hundred thirty five to two thousand two hundred thirty seven. Thygesen K et al. Fourth universal definition of myocardial infarction Journal of the American College of Cardiology twenty eighteen volume seventy two pages two thousand two hundred thirty one to two thousand two hundred sixty four.