TY - JOUR
T1 - International validation of the thrombolysis in myocardial infarction (TIMI) risk score for secondary prevention in post-mi patients
T2 - A collaborative analysis of the chronic kidney disease prognosis consortium and the risk validation scientific committee
AU - Mok, Yejin
AU - Ballew, Shoshana H.
AU - Bash, Lori D.
AU - Bhatt, Deepak L.
AU - Boden, William E.
AU - Bonaca, Marc P.
AU - Carrero, Juan Jesus
AU - Coresh, Josef
AU - D’Agostino, Ralph B.
AU - Elley, C. Raina
AU - Fowkes, F. Gerry R.
AU - Jee, Sun Ha
AU - Kovesdy, Csaba P.
AU - Mahaffey, Kenneth W.
AU - Nadkarni, Girish
AU - Peterson, Eric D.
AU - Sang, Yingying
AU - Matsushita, Kunihiro
N1 - Funding Information:
This specific study is supported by the US National Kidney Foundation (funding sources include Merck & Co., Inc, Kenilworth, NJ). The CKD-PC Data Coordinating Center is funded partly by a program grant from the US National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446-01). Various sources have supported enrollment and data collection including laboratory measurements and follow-up in the collaborating cohorts of the CKD-PC. These funding sources include government agencies such as National Institutes of Health and Medical Research Councils as well as Foundations and Industry sponsors listed in Data S3.
Funding Information:
This study was supported by Stockholm County Council and the Swedish Heart and Lung Foundation.
Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN2682017000021). The authors thank the staff and participants of the ARIC study for their important contributions.
Funding Information:
This study was funded by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea HI14C2686 and HI13C0715.
Funding Information:
This study was supported by grant R01DK096920 from NIH-NIDDK and is the result of work supported with resources and the use of facilities at the Memphis VA Medical Center and the Long Beach VA Medical Center. Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (project numbers SDR 02-237 and 98-004).
Publisher Copyright:
© 2018 The Authors.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - 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.
AB - 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.
KW - Myocardial infarction
KW - Secondary prevention
KW - Validati
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U2 - 10.1161/JAHA.117.008426
DO - 10.1161/JAHA.117.008426
M3 - Article
C2 - 29982232
AN - SCOPUS:85050502820
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 14
M1 - e008426
ER -