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

• Published in: Journal of the American Heart Association 2018-07, Vol.7 (14)
• Main Authors: Mok, Yejin, Ballew, Shoshana H, Bash, Lori D, Bhatt, Deepak L, Boden, William E, Bonaca, Marc P, Carrero, Juan Jesus, Coresh, Josef, D'Agostino, Sr, Ralph B, Elley, C Raina, Fowkes, F Gerry R, Jee, Sun Ha, Kovesdy, Csaba P, Mahaffey, Kenneth W, Nadkarni, Girish, Peterson, Eric D, Sang, Yingying, Matsushita, Kunihiro
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Brain Ischemia - epidemiology; Cardiovascular Diseases - mortality; Cohort Studies; Diabetes Mellitus - epidemiology; Female; Heart Failure - epidemiology; Humans; Hypertension - epidemiology; Male; Medicin och hälsovetenskap; Middle Aged; myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - therapy; New Zealand - epidemiology; Original Research; Peripheral Arterial Disease - epidemiology; Proportional Hazards Models; Recurrence; Renal Insufficiency - epidemiology; Reproducibility of Results; Republic of Korea - epidemiology; Risk Assessment; Secondary Prevention; Smoking - epidemiology; Stroke - epidemiology; Sweden - epidemiology; United States - epidemiology; validation
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.117.008426

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. 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). 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.