title: A prospective study of patients with refractory angina: outcomes and the role of high-sensitivity troponin T.
abstract: BACKGROUND
  The predictors of cardiovascular events in patients with chronic refractory angina are limited. High-sensitivity cardiac troponin T (hs-cTnT) assays are biomarkers that may be used to determine the prognosis of patients with stable coronary artery disease.
  
  
  OBJECTIVE
  Hs-cTnT is a predictor of death and nonfatal myocardial infarction (MI) in patients with refractory angina.
  
  
  METHODS
  We prospectively enrolled 117 consecutive patients in this study. A heart team ruled out myocardial revascularization feasibility after assessing recent coronary angiograms; evidence of myocardial ischemia served as an inclusion criterion. Optimal medical therapy was encouraged via outpatient visits every 6 months; plasma hs-cTnT levels were determined at baseline. The primary endpoint was the composite incidence of death and nonfatal MI.
  
  
  RESULTS
  During a median follow-up period of 28.0 months (interquartile range, 18.0-47.5 months), an estimated 28.0-month cumulative event rate of 13.4% was determined via the Kaplan-Meier method. Univariate predictors of the composite endpoint were hs-cTnT levels and LV dysfunction. Following a multivariate analysis, only hs-cTnT was independently associated with the events in question, either as a continuous variable (hazard ratio per unit increase in the natural logarithm: 2.83, 95% confidence interval: 1.62-4.92, P < 0.001) or as a categorical variable (hazard ratio for concentrations above the 99th percentile: 5.14, 95% confidence interval: 2.05-12.91, P < 0.001).
  
  
  CONCLUSIONS
  In patients with chronic refractory angina, plasma concentration of hs-cTnT is the strongest predictor of death and nonfatal MI. Notably, none of the outcomes in question occurred in patients with baseline plasma levels <5.0 ng/L.
authors.affiliation: Refractory Angina Research Group, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.|Clinical Unit of Chronic Coronary Heart Disease, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Nilson T
authors.initials: NT
authors.lastname: Poppi
authors.affiliation: Refractory Angina Research Group, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.|Laboratory of Genetics and Molecular Cardiology, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Luís H W
authors.initials: LH
authors.lastname: Gowdak
authors.affiliation: Refractory Angina Research Group, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.|Clinical Unit of Chronic Coronary Heart Disease, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciana O C
authors.initials: LO
authors.lastname: Dourado
authors.affiliation: Refractory Angina Research Group, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Adam
authors.affiliation: Refractory Angina Research Group, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.
authors.forename: Thiago N P
authors.initials: TN
authors.lastname: Leite
authors.affiliation: Clinical Unit of Chronic Coronary Heart Disease, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Mioto
authors.affiliation: Laboratory of Genetics and Molecular Cardiology, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: José E
authors.initials: JE
authors.lastname: Krieger
authors.affiliation: Clinical Unit of Chronic Coronary Heart Disease, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Luiz A M
authors.initials: LA
authors.lastname: César
authors.affiliation: Laboratory of Genetics and Molecular Cardiology, InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Alexandre C
authors.initials: AC
authors.lastname: Pereira
mesh_terms: D000787:Angina Pectoris / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: chronic refractory angina; high-sensitivity troponin; prognosis