Abstract
Guidelines recommend risk stratification tools for use in acute myocardial infarction (AMI) to assist decisions making. Few tools are, however, available to assist with decisions on long-term response to treatment. Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) has been recently propose for this indication. We aimed to assess the TRS-2P and to identify high-risk patients after AMI in the FAST-MI registries. We used data from 3 one-month French registries, conducted 5 years apart, from 2005 to 2015, including 13,130 patients with AMI [52% ST-elevation myocardial infarction (STEMI)] admitted to cardiac intensive care units. Atherothrombotic risk stratification was performed using the TRS-2P score. Patients were divided in 3 categories: G1 (Low-risk; TRS-2P = 0/1); G2 (Intermediate-risk; TRS-2P = 2); and, G3 (High-risk; TRS-2P ≥ 3). Baseline characteristics and outcomes were analyzed according to TRS-2P categories. A total of 12,715 patients (in whom TRS-2P was available) were included in this analysis. Prevalence of G1, G2, and G3 was 43%, 24% and 33% respectively. Clinical characteristics and management significantly differ according to TRS-2P categories. TRS-2P score successfully defined residual risk of death at one-year (C-statistic 0.78): 1-year survival was 98% in G1, 94% in G2, and 78.5% in G3 ( P < 0.001). Using Cox multivariate analysis, G3 was associated with higher rate of death at 1-year (HR = 4.61; 95% CI: 3.61–5.89), as G2 (HR = 2.08; 95% CI: 1.62–2.65) compared to G1. The score appeared robust and correlated well with mortality in STEMI and non-ST-elevation myocardial infarction (NSTEMI) populations, as well as in each cohort separately. The TRS-2P appears to be a robust risk score, identifying patients at high-risk after AMI irrespective of the type of MI and historical period.
Highlights
Risk stratification tools enable personalized risk assessment and may help guide therapeutic decision-making
The TRS-2P was validated in a clinical trial of acute coronary syndrome (ACS) patients followed for ~7 years.[12]
The TRS-2P score has never been evaluated in a routine-practice population, focusing on patients who are discharged after an acute myocardial infarction (AMI)
Summary
Guidelines recommend using risk stratification tools in acute myocardial infarction (AMI) to assist decision-making. The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) has been recently developed to characterize long-term risk in patients with MI. Methods: We used data from three 1-month French registries, conducted 5 years apart, from 2005 to 2015, including 13 130 patients with AMI (52% ST-elevation myocardial infarction [STEMI]). Atherothrombotic risk stratification was performed using the TRS-2P score. Baseline characteristics and outcomes were analyzed according to TRS-2P categories. Results: A total of 12 715 patients (in whom TRS-2P was available) were included. Clinical characteristics and management significantly differed according to TRS-2P categories. Conclusions: The TRS-2P appears to be a robust risk score, identifying patients at high risk after AMI irrespective of the type of MI and historical period
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