Atherothrombotic risk stratification after acute myocardial infarction: The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention in the light of the French Registry of Acute ST Elevation or non-ST Elevation Myocardial Infarction registries

Etienne Puymirat, Marc Bonaca, Maxime Fumery, Victoria Tea, Nadia Aissaoui, Gilles Lemesles, Laurent Bonello, Grégory Ducrocq, Guillaume Cayla, Jean Ferrières, François Schiele, Tabassome Simon, Nicolas Danchin, FAST-MI investigators, Etienne Puymirat, Marc Bonaca, Maxime Fumery, Victoria Tea, Nadia Aissaoui, Gilles Lemesles, Laurent Bonello, Grégory Ducrocq, Guillaume Cayla, Jean Ferrières, François Schiele, Tabassome Simon, Nicolas Danchin, FAST-MI investigators

Abstract

Background: 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.

Hypothesis: We aimed to assess the TRS-2P in the French Registry of Acute ST Elevation or non-ST elevation MI registries.

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. Patients were divided in to three 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.

Results: A total of 12 715 patients (in whom TRS-2P was available) were included. Prevalence of G1, G2, and G3 was 43%, 24%, and 33% respectively. Clinical characteristics and management significantly differed according to TRS-2P categories. TRS-2P successfully defined residual risk of death at 1 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 independently associated with higher risk of death at 1 year (hazard ratio [HR] 4.61; 95% confidence interval [CI]: 3.61-5.89), as G2 (HR 2.08; 95% CI: 1.62-2.65) compared with G1. The score appeared robust and correlated well with mortality in STEMI and NSTEMI populations, as well as in each cohort separately.

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.

Keywords: acute myocardial infarction; mortality; prevention; score.

© 2018 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Risk stratification of death at 1 year. One‐year Kaplan‐Meier estimates are shown. The P value is based on the χ2 test for trend. CABG, coronary artery bypass graft; CHF, congestive heart failure; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; HTN, hypertension; PAD, peripherical artery disease
Figure 2
Figure 2
One‐year mortality according to Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS2P) categories. The survival curves are unadjusted, and the adjusted hazard ratios (HRs) are provided with their 95% confidence intervals (CIs). NSTEMI, non‐ST‐elevation myocardial infarction; STEMI, ST‐elevation myocardial infarction

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Source: PubMed

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