Table 1.
Characteristics of Trial Participants With Myocardial Injury, Stratified by Sex and Study Phase
| Overall (N = 10,360) | Women |
Men |
|||||
|---|---|---|---|---|---|---|---|
| Overall (N = 4,991) | Validation (n = 2,072) | Implementation (n = 2,919) | Overall (N = 5,369) | Validation (n = 2,044) | Implementation (n = 3,325) | ||
| Age, yrs | 71 ± 15 | 75 ± 14 | 76 ± 14 | 74 ± 14 | 68 ± 15 | 68 ± 15 | 67 ± 15 |
| Presenting symptom∗ | |||||||
| Chest pain | 6,449 (70) | 2,880 (66) | 940 (64) | 1,940 (67) | 3,569 (74) | 1,076 (72) | 2,493 (75) |
| Dyspnea | 1,068 (12) | 575 (13) | 192 (13) | 383 (13) | 493 (10) | 173 (12) | 320 (10) |
| Palpitation | 278 (3) | 172 (4) | 58 (4) | 114 (4) | 106 (2) | 37 (3) | 69 (2) |
| Syncope | 686 (7) | 388 (9) | 153 (10) | 235 (8) | 298 (6) | 109 (7) | 189 (6) |
| Other | 730 (8) | 374 (9) | 128 (9) | 246 (8) | 356 (7) | 102 (7) | 254 (8) |
| Previous medical conditions | |||||||
| Myocardial infarction | 1,379 (13) | 631 (13) | 291 (14) | 340 (12) | 748 (14) | 325 (16) | 423 (13) |
| Ischemic heart disease | 3,457 (33) | 1,663 (33) | 773 (37) | 890 (31) | 1,794 (33) | 758 (37) | 1,036 (31) |
| Cerebrovascular disease | 1,034 (10) | 573 (12) | 265 (13) | 308 (11) | 461 (9) | 190 (9) | 271 (8) |
| Diabetes mellitus | 1,478 (14) | 664 (13) | 282 (14) | 382 (13) | 814 (15) | 329 (16) | 485 (15) |
| Previous revascularization | |||||||
| PCI | 938 (9) | 355 (7) | 148 (7) | 207 (7) | 583 (11) | 229 (11) | 354 (11) |
| CABG | 248 (2) | 76 (2) | 35 (2) | 41 (1) | 172 (3) | 76 (4) | 96 (3) |
| Medications at presentation | |||||||
| Aspirin | 3,701 (36) | 1,759 (35) | 800 (39) | 959 (33) | 1,942 (36) | 809 (40) | 1,133 (34) |
| P2Y12 inhibitor | 1,422 (14) | 750 (15) | 357 (17) | 393 (14) | 672 (13) | 296 (15) | 376 (11) |
| Dual-antiplatelet therapy† | 502 (5) | 228 (5) | 121 (6) | 107 (4) | 274 (5) | 139 (7) | 135 (4) |
| Statin | 5,260 (51) | 2,499 (50) | 1,100 (53) | 1,399 (48) | 2,761 (51) | 1,097 (54) | 1,664 (50) |
| ACE inhibitor or ARB | 4,333 (42) | 2,059 (41) | 876 (42) | 1,183 (41) | 2,274 (42) | 892 (44) | 1,382 (42) |
| Beta-blocker | 3,607 (35) | 1,809 (36) | 794 (38) | 1,015 (35) | 1,798 (34) | 762 (37) | 1,036 (31) |
| Oral anticoagulant agent‡ | 1,095 (11) | 587 (12) | 269 (13) | 318 (11) | 508 (10) | 204 (10) | 304 (9) |
| Loop diuretic agent | 2,693 (26) | 1,571 (32) | 702 (34) | 869 (30) | 1,122 (21) | 491 (24) | 631 (19) |
| Proton-pump inhibitor | 4,638 (45) | 2,472 (50) | 1,084 (52) | 1,388 (48) | 2,166 (40) | 862 (42) | 1,304 (39) |
| Calcium-channel blocker | 1,977 (19) | 921 (19) | 397 (19) | 524 (18) | 1,056 (19) | 412 (20) | 644 (19) |
| Nicorandil | 645 (6) | 303 (6) | 149 (7) | 154 (5) | 342 (6) | 174 (8) | 168 (5) |
| Ivabradine | 146 (1) | 68 (1) | 25 (1) | 43 (1) | 78 (1) | 33 (1) | 45 (1) |
| Spironolactone | 450 (4) | 201 (4) | 82 (4) | 119 (4) | 249 (4) | 113 (5) | 136 (4) |
| Electrocardiographic results§ | |||||||
| Normal | 2,672 (34) | 1,366 (36) | 513 (36) | 853 (36) | 1,306 (32) | 479 (34) | 827 (30) |
| Myocardial ischemia | 2,510 (32) | 1,023 (27) | 342 (24) | 681 (28) | 1,487 (36) | 445 (32) | 1,042 (38) |
| ST-segment elevation | 998 (13) | 329 (9) | 90 (6) | 239 (10) | 669 (16) | 174 (12) | 495 (18) |
| ST-segment depression | 1,328 (17) | 583 (16) | 226 (16) | 357 (15) | 745 (18) | 234 (17) | 511 (18) |
| T-wave inversion | 1,277 (16) | 640 (17) | 252 (17) | 388 (16) | 637 (15) | 232 (16) | 405 (15) |
| Physiological parameters§ | |||||||
| Heart rate, beats/min | 86 ± 26 | 88 ± 27 | 88 ± 27 | 88 ± 26 | 84 ± 26 | 85 ± 25 | 83 ± 26 |
| Systolic blood pressure, mm Hg | 139 ± 29 | 141 ± 30 | 140 ± 29 | 141 ± 30 | 137 ± 28 | 136 ± 28 | 137 ± 28 |
| GRACE risk score | 143 ± 38 | 147 ± 36 | 148 ± 34 | 147 ± 38 | 140 ± 39 | 139 ± 38 | 140 ± 40 |
| Hematologic and clinical chemistry measurements | |||||||
| Hemoglobin, g/l | 131 ± 25 | 125 ± 24 | 124 ± 24 | 126 ± 23 | 137 ± 25 | 136 ± 25 | 137 ± 25 |
| eGFR, ml/min | 47 ± 16 | 46 ± 16 | 47 ± 16 | 46 ± 16 | 49 ± 15 | 49 ± 16 | 48 ± 15 |
| Peak hs-cTnI, ng/l | 158 (45–1,622) | 82 (30–656) | 69 (28–464) | 93 (32–831) | 294 (67–3,006) | 216 (57–1,706) | 404 (76–4,395) |
| Serial hs-cTnI, %‖ | 6,983 ± 67 | 3,230 ± 65 | 1,298 ± 63 | 1,932 ± 66 | 3,753 ± 70 | 1,411 ± 69 | 2,342 ± 70 |
| Adjudicated diagnosis¶ | |||||||
| Type 1 MI | 5,028 (49) | 2,010 (46) | 748 (44) | 1,262 (47) | 3,018 (64) | 1,059 (62) | 1,959 (65) |
| Type 2 MI | 1,260 (12) | 700 (16) | 275 (16) | 425 (16) | 560 (12) | 187 (11) | 373 (12) |
| Nonischemic myocardial injury | 2,810 (27) | 1,673 (38) | 670 (40) | 1,003 (37) | 1,137 (24) | 448 (22) | 689 (21) |
Values are mean ± SD, n (%), or median (interquartile range).
ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; CABG = coronary artery bypass grafting; eGFR = estimated glomerular filtration rate; GRACE = Global Registry of Acute Coronary Events; hs-cTnI = high sensitivity cardiac troponin I; MI = myocardial infarction; PCI = percutaneous coronary intervention.
Presenting symptom was missing in 5,615 patients (12%).
Two medications from aspirin, clopidogrel, prasugrel, or ticagrelor.
Includes warfarin and direct oral anticoagulant agents.
Electrocardiographic and physiological data were available in 1,377 of reclassified patients (78%) and 6,470 of identified patients (75%).
Defined as 2 or more tests within 24 h of presentation.
The adjudication panel was able to achieve consensus diagnoses in 9,098 of 10,360 patients (88%) with hs-cTnI concentrations above the sex-specific 99th centile.