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International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post-MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee.

TitleInternational Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post-MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee.
Publication TypeJournal Article
Year of Publication2018
AuthorsMok Y, Ballew SH, Bash LD, Bhatt DL, Boden WE, Bonaca MP, Carrero JJesus, Coresh JJ, D'Agostino RB, C Elley R, F Fowkes GR, Jee SHa, Kovesdy CP, Mahaffey KW, Nadkarni G, Peterson ED, Sang Y
Secondary AuthorsMatsushita K
JournalJ Am Heart Assoc
Volume7
Issue14
Date Published2018 07 07
ISSN2047-9980
KeywordsAge Factors, Aged, Brain Ischemia, Cardiovascular Diseases, Cohort Studies, Diabetes Mellitus, Female, Heart Failure, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, New Zealand, Peripheral Arterial Disease, Proportional Hazards Models, Recurrence, Renal Insufficiency, Reproducibility of Results, Republic of Korea, Risk Assessment, Secondary Prevention, Smoking, Stroke, Sweden, United States
Abstract

BACKGROUND: The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS2°P), a 0-to-9-point system based on the presence/absence of 9 clinical factors, was developed to classify the risk of major adverse cardiovascular events (MACE) (a composite of cardiovascular death, recurrent myocardial infarction, or ischemic stroke) among patients with a recent myocardial infarction. Its performance has not been examined internationally outside of a clinical trial setting.

METHODS AND RESULTS: We evaluated the performance of TRS2°P for predicting MACE in 53 599 patients with recent myocardial infarction in 5 international cohorts from New Zealand, South Korea, Sweden, and the United States participating in the Chronic Kidney Disease Prognosis Consortium. Overall, there were 19 444 cases of MACE across 5 cohorts over a mean follow-up of 5 years, and the overall MACE rate ranged from 5.0 to 18.4 (per 100 person-years). The TRS2°P showed modest calibration (Brier score ranged from 0.144 to 0.173) and discrimination (C-statistics >0.61 in all studies except 1 from Korea with 0.55) across cohorts relative to its original Brier score of 0.098 and C-statistic of 0.67 in the derived data set. Although there was some heterogeneity across cohorts, the 9 predictors in the TRS2°P were generally associated with higher MACE risk, with strongest associations observed (meta-analyzed adjusted hazard ratio 1.6-1.7) for history of heart failure, age ≥75 years, and prior stroke, followed by peripheral artery disease, kidney dysfunction, diabetes mellitus, and hypertension (hazard ratio 1.3-1.4). Prior coronary bypass graft surgery and smoking did not reach statistical significance (hazard ratio ≈1.1).

CONCLUSIONS: TRS2°P, a simple scoring system with 9 routine clinical factors, was modestly predictive of secondary events when applied in patients with recent myocardial infarction from diverse clinical and geographic settings.

DOI10.1161/JAHA.117.008426
Alternate JournalJ Am Heart Assoc
PubMed ID29982232
PubMed Central IDPMC6064832
Grant ListR01 DK100446 / DK / NIDDK NIH HHS / United States