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Sex-specific diagnostic cut-offs may improve the test characteristics of high-sensitivity troponin assays for the diagnosis of myocardial infarction (MI). The objective of this study was to quantify test characteristics of sex-specific cut-offs of a single, high-sensitivity cardiac troponin T (hs-cTnT) assay for 7-day MI in patients with chest pain.
This observational cohort study included consecutive emergency department (ED) patients with suspected cardiac chest pain from four Canadian EDs who had an hs-cTnT assay performed within 60 minutes of ED arrival. The primary outcome was MI at 7 days. We quantified test characteristics (sensitivity, negative predictive value [NPV], likelihood ratios and proportion of patients ruled out) for multiple combinations of sex-specific, rule-out cut-offs. We calculated the net reclassification index compared to universal rule-out cut-offs.
In 7,130 patients (3,931 men and 3,199 women), the 7-day MI incidence was 7.38% among men and 3.78% among women. Optimal sex-specific cut-offs (<8 ng/L for men and <7 ng/L for women) had a 98.5% sensitivity for MI and ruled out MI in 55.8% of patients. This would enable an absolute increase in the proportion of patients who were able to be ruled out with a single hs-cTnT of 13.2% to 22.2%, depending on the universal rule-out concentration used as a comparator.
Sex-specific hs-cTnT cut-offs for ruling out MI at ED arrival may improve classification performance, enabling more patients to be safely ruled out at ED arrival. However, differences between sex-specific and universal cut-off concentrations are within the variation of the assay, limiting the clinical utility of this approach. These findings should be confirmed in other data sets.
In this second volume of the New South African Review, the New Growth Path adopted by the South African government in 2010 provides the basis for a dialogue about whether ‘decent work’ is the best solution to South Africa’s problems of low economic growth and high unemployment. There are investigations into rising inequality against the backdrop of the failings of Black Economic Empowerment; ‘greening the economy’, with emphasis on biofuels; the crisis of acid mine drainage on the Witwatersrand; possibilities for participatory forms of government; civil society activism; transformation of the print media and the SABC; the crisis in child care in public hospitals; the relationship between the police and a township community; the problems related to the absence of legislation to govern the powers of traditional authorities over land allocation; and assessments of the state of opposition political parties and the ANC Alliance. Asking whether the New Growth Plan reflects a set of new policies or an attempt to re-dress old (com)promises in new clothes, this volume brings together different voices in debate about possibilities for alternatives to neo-liberal and capitalist development in South Africa.