Evidence of gender bias when applying the new diagnostic criteria for myocardial infarction.

I n 2000, the European Society of Cardiology and the American College of Cardiology presented new diagnostic criteria for myocardial infarction (MI) which placed a greater emphasis on cardiac markers by stating that any elevation in cardiac troponin T (cTnT) or cardiac troponin I (cTnI) above the 99th centile of normal was sufficient to diagnose a MI. Recent studies since then have shown that the wholesale adoption of these new criteria would lead to a substantial increase in MI incidence. As a separate issue, it has been repeatedly shown that women diagnosed as having had an MI tend to be managed less aggressively and have a poorer prognosis compared to men. However, since women tend to present when they are older it has been disputed that age rather than sex bias may be the reason. This study therefore aimed to establish the extent to which the new criteria for MI were being applied to patients admitted to a busy UK teaching hospital and to determine whether any age or sex bias may exist when making this diagnosis.