TY - JOUR
T1 - Danspot
T2 - A Multicenter Stepped-Wedge Cluster-Randomized Trial of the Reclassification of Acute Myocardial Infarction: Rationale and Study Design
AU - Strandkjær, Nina
AU - Jørgensen, Nicoline
AU - Hasselbalch, Rasmus Bo
AU - Kristensen, Jonas
AU - Knudsen, Marie Sophie Sander
AU - Kock, Thilde Olivia
AU - Lange, Theis
AU - Lindholm, Matias Greve
AU - Bruun, Niels Eske
AU - Holmvang, Lene
AU - Terkelsen, Christian Juhl
AU - Pedersen, Claus Kjær
AU - Christensen, Martin Kirk
AU - Lassen, Jens Flensted
AU - Hilsted, Linda
AU - Ladefoged, Søren
AU - Nybo, Mads
AU - Bor, Mustafa Vakur
AU - Dahl, Morten
AU - Hansen, Annebirthe Bo
AU - Kamstrup, Pia Rørbæk
AU - Bundgaard, Henning
AU - Torp-Pedersen, Christian
AU - Iversen, Kasper Karmark
PY - 2024/4/19
Y1 - 2024/4/19
N2 - BACKGROUND: Cardiac troponins are the preferred biomarkers for the diagnosis of acute myocardial infarction. Although sex-specific 99th percentile thresholds of troponins are recommended in international guidelines, the clinical effect of their use is poorly investigated. The DANSPOT Study (The Danish Study of Sex- and Population-Specific 99th percentile upper reference limits of Troponin) aims to evaluate the clinical effect of a prospective implementation of population- and sex-specific diagnostic thresholds of troponins into clinical practice.METHODS: This study is a nationwide, multicenter, stepped-wedge cluster-randomized trial of the implementation of population- and sex-specific thresholds of troponins in 22 of 23 clinical centers in Denmark. We established sex-specific thresholds for 5 different troponin assays based on troponin levels in a healthy Danish reference population. Centers will sequentially cross over from current uniform manufacturer-derived thresholds to the new population- and sex-specific thresholds. The primary cohort is defined as patients with symptoms suggestive of acute coronary syndrome having at least 1 troponin measurement performed within 24 hours of arrival with a peak troponin value between the current uniform threshold and the new sex-specific female and male thresholds. The study will compare the occurrence of the primary outcome, defined as a composite of nonfatal myocardial infarction, unplanned revascularization, and all-cause mortality within 1 year, separately for men and women before and after the implementation of the new sex-specific thresholds.CONCLUSIONS: The DANSPOT Study is expected to show the clinical effects on diagnostics, treatment, and clinical outcomes in patients with myocardial infarction of implementing sex-specific diagnostic thresholds for troponin based on a national Danish reference population.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05336435.
AB - BACKGROUND: Cardiac troponins are the preferred biomarkers for the diagnosis of acute myocardial infarction. Although sex-specific 99th percentile thresholds of troponins are recommended in international guidelines, the clinical effect of their use is poorly investigated. The DANSPOT Study (The Danish Study of Sex- and Population-Specific 99th percentile upper reference limits of Troponin) aims to evaluate the clinical effect of a prospective implementation of population- and sex-specific diagnostic thresholds of troponins into clinical practice.METHODS: This study is a nationwide, multicenter, stepped-wedge cluster-randomized trial of the implementation of population- and sex-specific thresholds of troponins in 22 of 23 clinical centers in Denmark. We established sex-specific thresholds for 5 different troponin assays based on troponin levels in a healthy Danish reference population. Centers will sequentially cross over from current uniform manufacturer-derived thresholds to the new population- and sex-specific thresholds. The primary cohort is defined as patients with symptoms suggestive of acute coronary syndrome having at least 1 troponin measurement performed within 24 hours of arrival with a peak troponin value between the current uniform threshold and the new sex-specific female and male thresholds. The study will compare the occurrence of the primary outcome, defined as a composite of nonfatal myocardial infarction, unplanned revascularization, and all-cause mortality within 1 year, separately for men and women before and after the implementation of the new sex-specific thresholds.CONCLUSIONS: The DANSPOT Study is expected to show the clinical effects on diagnostics, treatment, and clinical outcomes in patients with myocardial infarction of implementing sex-specific diagnostic thresholds for troponin based on a national Danish reference population.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05336435.
KW - acute coronary syndrome
KW - biomarkers
KW - myocardial infarction
KW - sex factors
KW - troponin
U2 - 10.1161/JAHA.123.033493
DO - 10.1161/JAHA.123.033493
M3 - Journal article
C2 - 38639348
SN - 2047-9980
VL - 13
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e033493
ER -