External validation of the TIMI risk score for secondary cardiovascular events among patients with recent myocardial infarction
| Autor: | Kevin Chagin, Lori D. Bash, Mehul D. Patel, William E. Boden, Michael W. Kattan, Kenneth W. Mahaffey, F. Gerry R. Fowkes, Marc P. Bonaca, Brent A. Williams, Eric D. Peterson, Ralph B. D'Agostino, Sue Duval, Deepak L. Bhatt |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Pyridines Myocardial Infarction 030204 cardiovascular system & hematology Risk Assessment Severity of Illness Index 03 medical and health sciences Lactones 0302 clinical medicine Double-Blind Method Internal medicine medicine Secondary Prevention Electronic Health Records Humans 030212 general & internal medicine Myocardial infarction Aged Retrospective Studies Secondary prevention Framingham Risk Score business.industry Medical record Reproducibility of Results Retrospective cohort study Middle Aged medicine.disease Stroke Cardiovascular Diseases Risk stratification Calibration Female Cardiology and Cardiovascular Medicine business TIMI Platelet Aggregation Inhibitors Recent myocardial infarction |
| Zdroj: | Atherosclerosis. 272 |
| ISSN: | 1879-1484 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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