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Editor's Note
May 13, 2013

Is There a Role for Further Risk Stratification of Patients With Stable Coronary Artery Disease?Comment on “High-Sensitivity Cardiac Troponin T Levels and Secondary Events in Outpatients With Coronary Heart Disease From the Heart and Soul Study”

JAMA Intern Med. 2013;173(9):770. doi:10.1001/jamainternmed.2013.694

The article by Beatty et al demonstrated an independent association between high-sensitivity cardiac troponin T levels and recurrent events among patients with known stable coronary artery disease, even after controlling for important potential confounders, including structural and functional heart disease factors. This association implies that we have the capability to refine risk prediction further among such already high-risk patients. However, whether we should do so is another question, because it is unclear how such information would change clinical management. Patients with low troponin levels still had a high risk for recurrent events (an approximately 20% 10-year risk), and would not warrant cessation of conventionally accepted treatments for the prevention of recurrent events. Among patients with high troponin levels, one can consider having a more nuanced discussion about prognosis, or consider enrollment in clinical trials to assess new advances in the secondary prevention of coronary syndromes; but whether this results in improved patient-centered outcomes is unknown. As is the case with obtaining any new clinical information, we would not recommend the routine use of this laboratory test unless the results are tied to an evidence-based management decision that leads to improved outcomes, and the patient is adequately informed of its uncertain utility.