High-Sensitivity Cardiac Troponin I for Predicting Death in a Female Emergency Department Population
Bibliographic record
Abstract
To the Editor: The Third Universal Definition of Myocardial Infarction has indicated that “sex-dependent values may be recommended for high-sensitivity troponin assays” (1). This statement is supported by several reference-interval studies that reported that women had lower concentrations and 99th percentile cutoffs with the high-sensitivity assays than men (2, 3). Despite these findings, it is unclear whether this information—gained only from the use of high-sensitivity assays—would be important for diagnostic or prognostic purposes in the female population. Presently, only Roche Diagnostics' high-sensitivity cardiac troponin T (hs-cTnT)1 assay and Abbott Diagnostics' high-sensitivity cardiac troponin I (hs-cTnI) assay have been approved by regulatory bodies. These assays are in clinical use throughout the world (outside the US). Roche has discontinued the fourth-generation cTnT assay in jurisdictions where the hs-cTnT assay has achieved regulatory approval; therefore, prospective comparisons of the readjusted hs-cTnT assay (in 2012) and the fourth-generation assay for assessing sex-specific clinical performance are no longer possible in many regions. Nevertheless, studies that assess both high-sensitivity and sensitive cTnI assays with respect to health outcomes in the female population are essential if sex-specific cutoffs are to be used. To this end, we performed a large prospective observational study of emergency department (ED) patients to assess whether an incremental benefit for predicting hospital death for women at presentation (compared with men) exists when a high-sensitivity cardiac troponin assay is used, vs. a sensitive cardiac troponin assay. After ethics approval was obtained, every adult patient who presented to the ED at the Hamilton General Hospital and Juravinski Hospital and had a cTnI test (ARCHITECT STAT TnI; Abbott Diagnostics) and results over a period of 3 months also had the same sample measured with a …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".