External validation of the TIMI risk score for secondary cardiovascular events among patients with recent myocardial infarction. (May 2018)

• Record Type: Journal Article
• Authors: Williams, Brent A.; Chagin, Kevin M.; Bash, Lori D.; Boden, William E.; Duval, Sue; Fowkes, F. Gerry R.; Mahaffey, Kenneth W.; Patel, Mehul D.; D'Agostino, Ralph B.; Peterson, Eric D.; Kattan, Michael W.; Bhatt, Deepak L.; Bonaca, Marc P.
• Is Part Of: Atherosclerosis. Volume 272(2018)
• Page Start: 80
• Page End: 86
• Publication Date: 2018-05
• Subjects: Myocardial infarction -- Secondary prevention -- Risk stratification -- Electronic medical record; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2018.03.026
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Risk stratification of patients with recent myocardial infarction (MI) for subsequent cardiovascular (CV) events helps identify patients most likely to benefit from secondary prevention therapies. This study externally validated a new risk score (TRS2˚P) for secondary events derived from the TRA2°P-TIMI 50 trial among post-MI patients from two large health care systems. Methods: This retrospective cohort study included 9618 patients treated for acute MI at either the Cleveland Clinic (CC) or Geisinger Health System (GHS) between 2008 and 2013. Patients with a clinic visit within 2–52 weeks of MI were included and followed for CV death, repeat MI, and ischemic stroke through electronic medical records (EMR). The TRS2˚P is based on nine factors determined through EMR documentation. Discrimination and calibration of the TRS2˚P were quantified in both patient populations. Results: MI patients at CC and GHS were older, had more comorbidities, received fewer medications, and had higher 3-year event rates compared to subjects in the TRA2°P trial: 31% (CC), 33% (GHS), and 10% (TRA2°P-TIMI 50). The proposed risk score had similar discrimination across the three cohorts with c-statistics of 0.66 (CC), 0.66 (GHS), and 0.67 (TRA2°P-TIMI 50). A strong graded relationship between the risk score and event rates was observed in all cohorts, though 3-year event rates were consistently higher within TRS2°P strata in the CC and GHS cohorts relative to TRA2˚P-TIMI 50. Conclusions: The TRS2˚P demonstrated consistent risk discrimination across trial and non-trial patients with recent MI, but event rates were consistently higher in the non-trial cohorts. Highlights: Validation of the TIMI risk score for 2° prevention (TRS2˚P) in recent MI was performed. The TRS2˚P showed acceptable discrimination in non-trial, real-world patients. The TRS2˚P underestimated absolute risk in non-trial, real-world patients. High risk patients as identified by the TRS2˚P may warrant additional therapy.