{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T17:29:13Z","timestamp":1767979753617,"version":"3.49.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2017,9,1]],"date-time":"2017-09-01T00:00:00Z","timestamp":1504224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"bioMerieux"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>The use of sex-specific cutoffs for cardiac troponin (cTn) is currently debated. Although endorsed by scientific working groups, concerns have been raised that sex-specific cutoffs may have only a small clinical effect at the cost of increased complexity in decision-making.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We reviewed studies investigating the interrelations between high-sensitivity (hs) cTn results and sex, diagnoses, and outcome. Investigated populations included community-dwelling subjects and patients with stable angina, congestive heart failure, or acute chest pain including those with acute coronary syndromes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Men usually have higher hs-cTn concentrations compared with women, regardless of the assessed population or the applied assay. The distribution and prognostic implications of hs-cTn concentrations indicate that women have a broader cardiovascular risk panorama compared with men, particularly at lower hs-cTn concentrations. At higher concentrations, particularly above the 99th percentile, this variation is often attenuated. Sex-specific hs-cTn 99th percentiles have so far shown clinical net benefit in only 1 study assessing patients with chest pain. However, several methodological aspects need to be considered when interpreting study results, e.g., issues related to the determination of the 99th percentiles, the selection bias, and the lack of prospective and sufficiently powered analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Available studies do not show a consistent clinical superiority of sex-specific hs-cTn 99th percentiles. This may reflect methodological aspects. However, from a pathobiological perspective, the use of sex-specific hs-cTn 99th percentiles makes sense for the ruling in of myocardial infarction. We propose a new approach to hs-cTn 99th cutoffs taking into account the analytical properties of the used assays.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1373\/clinchem.2017.271684","type":"journal-article","created":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T00:50:25Z","timestamp":1497919825000},"page":"1457-1464","source":"Crossref","is-referenced-by-count":42,"title":["Impact of Sex on Cardiac Troponin Concentrations\u2014A Critical Appraisal"],"prefix":"10.1093","volume":"63","author":[{"given":"Kai M","family":"Eggers","sequence":"first","affiliation":[{"name":"Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertil","family":"Lindahl","sequence":"first","affiliation":[{"name":"Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,9,1]]},"reference":[{"key":"2020022606140003600_B1","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1016\/j.jacc.2011.01.029","article-title":"Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis?","volume":"57","author":"White","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2020022606140003600_B2","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/S0735-1097(00)00804-4","article-title":"Myocardial infarction redefined\u2014a consensus document of the joint European Society of Cardiology\/American College of Cardiology Committee for the Redefinition of Myocardial Infarction","volume":"36","author":"Alpert","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2020022606140003600_B3","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1373\/clinchem.2013.211706","article-title":"The global need to define normality: the 99th percentile value of cardiac troponin","volume":"60","author":"Sandoval","year":"2014","journal-title":"Clin Chem"},{"key":"2020022606140003600_B4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1373\/clinchem.2016.255109","article-title":"Cardiac troponin assays: guide to understanding analytical characteristics and their impact on clinical care","volume":"63","author":"Apple","year":"2017","journal-title":"Clin Chem"},{"key":"2020022606140003600_B5","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1161\/CIR.0b013e31826e1058","article-title":"Third universal definition of myocardial infarction","volume":"126","author":"Thygesen","year":"2012","journal-title":"Circulation"},{"key":"2020022606140003600_B6","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.clinbiochem.2014.06.008","article-title":"Men are different than women: it's true for cardiac troponin too","volume":"47","author":"Apple","year":"2014","journal-title":"Clin Biochem"},{"key":"2020022606140003600_B7","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1373\/clinchem.2016.254672","article-title":"Point: the use of sex-specific cutpoints for high-sensitivity cardiac troponin assays","volume":"63","author":"Cullen","year":"2017","journal-title":"Clin Chem"},{"key":"2020022606140003600_B8","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1373\/clinchem.2016.254680","article-title":"Counterpoint: potential concerns regarding the use of sex-specific cutpoints for high-sensitivity troponin assays","volume":"63","author":"Giannitsis","year":"2017","journal-title":"Clin Chem"},{"key":"2020022606140003600_B9","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1016\/j.jacc.2013.12.032","article-title":"Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay","volume":"63","author":"Gore","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2020022606140003600_B10","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.cca.2010.12.034","article-title":"Multicenter analytical evaluation of a high-sensitivity troponin T assay","volume":"412","author":"Saenger","year":"2011","journal-title":"Clin Chim Acta"},{"key":"2020022606140003600_B11","unstructured":"U.S. Food & Drug Administration. http:\/\/www.accessdata.fda.gov\/cdrh_docs\/reviews\/K162895.pdf (Accessed February 2017)."},{"key":"2020022606140003600_B12","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1136\/heartjnl-2015-308917","article-title":"Direct comparison of clinical decision limits for cardiac troponin T and I","volume":"102","author":"Kimenai","year":"2016","journal-title":"Heart"},{"key":"2020022606140003600_B13","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/S0735-1097(02)01712-6","article-title":"Gender differences and normal left ventricular anatomy in an adult population free of hypertension. 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