Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain

Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain

Background: Biomarkers are used for long-term risk prediction of cardiovascular (CV) events in patients presenting with suspected acute coronary syndromes. Objectives: This study investigated whether there are sex differences in the long-term prognostic value of biomarkers in patients presenting wit...

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Main Authors: Gard Mikael Sæle Myrmel, MD, Nasir Saeed, Ole Thomas Steiro, MD, Hilde Lunde Tjora, MD, PhD, Jørund Langørgen, MD, PhD, Rune Oskar Bjørneklett, MD, PhD, Øyvind Skadberg, MD, Vernon Vijay Singha Bonarjee, MD, PhD, Øistein Rønneberg Mjelva, MD, Eva Ringdal Pedersen, MD, PhD, Kjell Vikenes, MD, PhD, Torbjørn Omland, MD, PhD, Kristin Moberg Aakre, MD, PhD
Format: Article
Language:English
Published: Elsevier 2025-02-01
Series:JACC: Advances
Subjects:
acute chest pain
biomarkers
risk stratification
sex differences
Online Access:http://www.sciencedirect.com/science/article/pii/S2772963X24008482
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Summary:Background: Biomarkers are used for long-term risk prediction of cardiovascular (CV) events in patients presenting with suspected acute coronary syndromes. Objectives: This study investigated whether there are sex differences in the long-term prognostic value of biomarkers in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: High-sensitivity cardiac troponin (hs-cTn), hs-cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor (GDF)-15, and C-reactive protein (CRP) concentrations were measured in 1,476 patients admitted with suspected NSTE-ACS. Patients were followed up for a median of 1,547 (IQR: 873-1,842) days until a primary composite endpoint of all-cause mortality, incident myocardial infarction, or heart failure hospitalization. A secondary endpoint of CV death was also registered. Results: For the primary endpoint, a log2 increase of hs-cTn and hs-cTnI concentration was associated with a higher adjusted hazard ratio in women (hs-cTn: 1.3, 95% CI: 1.2-1.5; hs-cTnI: 1.2, 95% CI: 1.1-1.2) than in men (hs-cTn: 1.1, 95% CI: 1.0-1.2; hs-cTnI: 1.0, 95% CI: 1.0-1.1); P value for interaction with sex: 0.009 (hs-cTn) and 0.005 (hs-cTnI). A similar interaction was shown for NT-proBNP (P for interaction: 0.043). GDF-15 and CRP were independent predictors of the primary endpoint, but the interaction by sex was nonsignificant. Conclusions: In contrast to CRP and GDF-15, increasing concentrations of hs-cTn, hs-cTnI, and NT-proBNP are associated with higher risk of death and CV events in female than in male patients presenting with suspected NSTE-ACS. Sex-adjustment of hs-cTn and NT-proBNP may increase the accuracy of long-term CV prognostication in women and men.
ISSN:2772-963X

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