Discussion
SECONDARY, CORONARY HEART DISEASE, EVENT
Patients with elevated cTnT one year after MI, PCI or CABG had decreased long-term composite endpoint-free and crude survival compared to patients with low cTnT values and achieved slightly less secondary preventive targets for cardiovascular risk factors.About 30% of all participants experienced a new major cardiovascular event (MACE) during the median follow-up period of 5.7 years. Elevated cTnT was associated to poorer outcome. Cardiac TnT is reported from other studies to be a robust predictor of mortality [The prevalence of elevated cTnT (19%) in our study population of patients with chronic stable coronary heart disease was comparable with previous studies [Patients with elevated cTnT reached slightly less targets for secondary prevention than patients with low cTnT values. Although the results cannot prove causal relations between achievement of the treatment targets and cTnT values, the study revealed a potential for improvement in the overall rate of treatment target achievement for all patients. 30–50% of the participants did not reach the treatment targets for blood-pressure and LDL-cholesterol. Most of the patients did not achieve treatment targets for the lifestyle factors body mass index, smoking, and physical activity. We find reason to stress the importance of adherence to the secondary preventive guideline from ESC, AHA and ACC for all patients.More patients in the hospital-based follow-up group had elevated cTnT compared to the primary care follow-up group. Taking in account the observational value of the results in this subanalysis, we may just suppose some possible explanations. One of these might be that patients in hospital follow-up (intervention) group were more compliant to the follow-up across the whole group, while in primary care follow-up group patients with multiple comorbidities and more complex medical history dropped the out-patient consultations in greater extent due to comorbidities itself or concurring appointments. In the latter group out-patient consultations included only data collection without intervention, thus probably patients with greater morbidity and more frequent appointment burden would prioritize those appointments with greater clinical relevance.In our opinion, the study results indicate a potential usefulness of cTnT in secondary preventive follow-up after MI, PCI and/or CABG. Measurements of cTnT identify patients at high risk who may benefit from further optimalization of secondary preventive therapy.This study was limited to one hospital and a limited number of endpoints. Smoking status, amount of exercise and use of medications were self-reported, and likely to be affected by reporting bias. Furthermore, we lacked information regarding left ventricular systolic function in most patients. Nevertheless, this study included patients from both hospital-based and primary care based secondary preventive follow-up and represents a real-life population of patients with stable coronary heart disease.