TIMI risk score for secondary prevention of recurrent cardiovascular events in a real world cohort of post acute ST-elevation myocardial infarction patients

Abstract

Background: Patients who survive ST-elevation myocardial infarction (STEMI) are at risk of recurrent cardiovascular events. Data on long-term secondary atherothrombotic risk assessment to identify high-risk patients are limited. Purpose: To stratify post-STEMI patients for risk of recurrent cardiovascular events to maximise benefit from aggressive secondary prevention strategies using the recently developed Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P) score in a real world cohort of post-STEMI patients. Methods: This was an observational study that applied the TRS 2°P score to a consecutive cohort of 797 post-STEMI patients (66.5±13.7 years; male: 73%). The TRS 2°P is a 9-point risk stratification tool to predict cardiovascular events in patients with established cardiovascular disease. The primary outcome was a composite endpoint of cardiovascular death, non-fatal MI, and non-fatal ischemic stroke. Results: After a mean follow-up of 44.4±34.4 months, 124 patients (15.6%) had developed a primary outcome (5.6%/year) including 83 cardiovascular deaths, 40 non-fatal MIs, and 11 non-fatal strokes. The TRS 2°P score was strongly associated with the primary outcome. The annual incidence of primary composite endpoint for patients with TRS 2°P score = 0 was 0.7%, and increased progressively to 19.3% for those with TRS 2°P score ≥6 (HR: 21.76, 95% CI: 4.22–112.21, p<0.001). Similar associations was also observed between the TRS 2°P score and MI (fetal and non-fatal), but not cardiovascular death and non-fatal ischemic stroke. Conclusion: The TRS 2°P reliably stratified post-STEMI patients for risk of future cardiovascular events and might help guide the selection of more aggressive therapy such as monoclonal antibody to PCSK9.