{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:40:50Z","timestamp":1785804050388,"version":"3.56.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005029","name":"Western Norway Regional Health Authority","doi-asserted-by":"publisher","award":["912265"],"award-info":[{"award-number":["912265"]}],"id":[{"id":"10.13039\/501100005029","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005029","name":"Western Norway Regional Health Authority","doi-asserted-by":"publisher","award":["ID F-12501"],"award-info":[{"award-number":["ID F-12501"]}],"id":[{"id":"10.13039\/501100005029","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["SP\/12\/10\/29922"],"award-info":[{"award-number":["SP\/12\/10\/29922"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["PG\/15\/51\/31596"],"award-info":[{"award-number":["PG\/15\/51\/31596"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NHS Scotland Health Informatics Challenge Grant","award":["HICG\/1\/40"],"award-info":[{"award-number":["HICG\/1\/40"]}]},{"name":"British Heart Foundation Personal Chair Scholarship","award":["CH\/F\/21\/90010"],"award-info":[{"award-number":["CH\/F\/21\/90010"]}]},{"name":"British Heart Foundation Research Excellence Award","award":["RE\/24\/130012"],"award-info":[{"award-number":["RE\/24\/130012"]}]},{"name":"Programme Grant","award":["RG\/F\/25\/110169"],"award-info":[{"award-number":["RG\/F\/25\/110169"]}]},{"name":"Chair Award","award":["CH\/F\/21\/90010"],"award-info":[{"award-number":["CH\/F\/21\/90010"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sex-specific diagnostic thresholds for high-sensitivity cardiac troponin (hs-cTn) assays are recommended by international guidelines for the diagnosis of myocardial infarction (MI). We assessed the performance of sex-specific single-sample rule-out thresholds for identifying low-risk patients in the emergency department.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The derivation cohort comprised patients \u226518 years presenting with suspected MI to 2 Norwegian hospitals between 2015 and 2020 with 0-hour hs-cTnT (Roche) and high-sensitivity cardiac troponin I (Abbott and Siemens) measurements available. The primary endpoint was type 1 MI at index encounter. Diagnoses were adjudicated using assay-specific criteria per the Fourth Universal Definition of Myocardial Infarction. Sex-specific single-sample rule-out thresholds were derived, compared with guideline-recommended uniform thresholds, and externally validated in an independent and comparable British cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1896 patients [median age 62 (25th\u201375th percentile 52\u201372) years; 39% female], MI occurred in 12.5%\u201312.8% males and 8.8%\u20139.2% females, depending on the adjudication assay.<\/jats:p>\n                    <jats:p>For each assay, more females had hs-cTn concentrations below the uniform single-sample thresholds, yet these thresholds did not achieve &amp;gt;99% sensitivity in females. Sex-specific adjustment achieved &amp;gt;99% sensitivity at cutoffs of &amp;lt;4 and &amp;lt;7 ng\/L (Roche); &amp;lt;1 and &amp;lt;6 ng\/L (Abbott); &amp;lt;2 and &amp;lt;7 ng\/L (Siemens) for females and males, respectively. Sex-specific thresholds reduced rule-out proportions in females (from 29%\u201360% to 10%\u201332%) and increased them in males (from 17%\u201353% to 45%\u201364%). Trends were similar in the validation cohort of 1948 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Uniform single-sample rule-out thresholds reveal marked sex differences in MI risk stratification. Sex-specific hs-cTn thresholds could improve safety in females and efficiency in males.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>ClinicalTrials.gov Registration Numbers<\/jats:title>\n                    <jats:p>NCT02620202; NCT01852123.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/clinchem\/hvag030","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T12:52:08Z","timestamp":1773233528000},"page":"868-879","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Sex-Specific High-Sensitivity Cardiac Troponin Thresholds for Rule-Out of Non-ST-Elevation Myocardial Infarction"],"prefix":"10.1093","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8922-7014","authenticated-orcid":false,"given":"Ingar Ziad","family":"Restan","sequence":"first","affiliation":[{"name":"Department of Cardiology, Stavanger University Hospital , Stavanger ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Yong","family":"Tew","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2520-9436","authenticated-orcid":false,"given":"Ole-Thomas","family":"Steiro","sequence":"additional","affiliation":[{"name":"Department of Heart Disease, Haukeland University Hospital , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1668-0229","authenticated-orcid":false,"given":"Ziwen","family":"Li","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde L","family":"Tjora","sequence":"additional","affiliation":[{"name":"Emergency Care Clinic, Haukeland University Hospital , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f8rund","family":"Lang\u00f8rgen","sequence":"additional","affiliation":[{"name":"Department of Heart Disease, Haukeland University Hospital , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torbj\u00f8rn","family":"Omland","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Akershus University Hospital , Oslo ,","place":["Norway"]},{"name":"K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7000-5996","authenticated-orcid":false,"given":"Paul","family":"Collinson","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, City St.George's, University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rune","family":"Bj\u00f8rneklett","sequence":"additional","affiliation":[{"name":"Emergency Care Clinic, Haukeland University Hospital , Bergen ,","place":["Norway"]},{"name":"Department of Clinical Medicine, University of Bergen , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4794-6269","authenticated-orcid":false,"given":"Kjell","family":"Vikenes","sequence":"additional","affiliation":[{"name":"Department of Heart Disease, Haukeland University Hospital , Bergen ,","place":["Norway"]},{"name":"Department of Clinical Science, University of Bergen , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3320-4010","authenticated-orcid":false,"given":"Trude","family":"Steinsvik","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Vestre Viken Hospital , B\u00e6rum ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8yvind","family":"Skadberg","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biochemistry, Stavanger University Hospital , Stavanger 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