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Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE-MI)

Principal Investigators: Drs. Karin Humphries and Jim Christenson
Co-investigators: Drs. Aslam Anis, Frank Scheuermeyer, Joel Singer, Wei Zhang

Status: Ongoing

Women with heart disease are under-diagnosed, under-treated, and have worse outcomes than men. Among young women (<55 years) with a heart attack, the risk of death is 2X higher than among men of the same age. With the introduction of a more sensitive diagnostic test — high sensitivity cardiac troponin (hs-cTn), it has become apparent that using a single level (cut-point) to identify patients with a heart attack disadvantages women. Hs-cTn is a biomarker, or protein, released into the blood when the heart is damaged during heart attack. Women produce lower amounts of this biomarker when they have a heart attack than men. Using a lower cut-point for hs-cTn in women, has the potential to identify more women who have had damage to their hearts, and this will allow for the provision of better care, leading to better outcomes for these women.

The study, led by Drs. Karin Humphries and Jim Christenson, will be conducted in 26 emergency departments (EDs) across Canada. Every site will start using the standard single cut-point to identify patients with heart attack or heart damage. Randomly, they will be asked to change practice in their hospitals by using a lower cut-point for women; the cut-point for men will remain unchanged. At the end of the study, every ED will be using the lower cut-point in women.

This study aims to evaluate the impact of using the female-specific cut-point for hs-cTn compared to the overall cut-point, on the diagnosis, treatment, and outcomes of females presenting to the emergency department with chest pain. Specifically, the impact of female-specific cut-points on the following will be examined:

  • Diagnostic and therapeutic strategies;
  • Prognosis: 30-day and 1-year all-cause mortality, non-fatal MI, incident heart revascularization; and
  • Costs of diagnostic testing and treatment.

View the study website here.

Health research in the heart of Vancouver