Open AccessInternational 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
Author(s) -
Mok Yejin,
Ballew Shoshana H.,
Bash Lori D.,
Bhatt Deepak L.,
Boden William E.,
Bonaca Marc P.,
Carrero Juan Jesus,
Coresh Josef,
D'Agostino 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
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.008426
Subject(s) - medicine , mace , timi , myocardial infarction , hazard ratio , framingham risk score , thrombolysis , stroke (engine) , kidney disease , cardiology , disease , percutaneous coronary intervention , confidence interval , mechanical engineering , engineering
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.