Atherothrombotic risk stratification after acute myocardial infarction: the TIMI Risk Score for Secondary Prevention (TRS‐2P) in the light of the FAST‐MI registries

Etienne Puymirat (1) , Marc P Bonaca (2) , Maxime Fumery (1) , Victoria Tea (1) , Nadia Aissaoui (1) , Gilles Lemesles (3) , Laurent Bonello (4) , Grégory Ducrocq (5) , Guillaume Cayla (6) , Jean Ferrières (7, 8) , Francois Schiele (9) , Tabassome Simon (10) , Nicolas Danchin (11)

1 HEGP - Hôpital Européen Georges Pompidou [APHP]
2 HMS - Harvard Medical School [Boston]
3 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
4 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
5 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
6 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
7 Service Epidémiologie clinique et santé publique [CHU Toulouse]
8 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
9 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
10 CHU Saint-Antoine [AP-HP]
11 CESP - Centre de recherche en épidémiologie et santé des populations

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.

Mots clés: :acute myocardial infarction; mortality; prevention; score; ACUTE CORONARY SYNDROMES; ASSOCIATION TASK-FORCE; FAST-MI; HOSPITAL MORTALITY; AMERICAN-COLLEGE; HEART-DISEASE; MANAGEMENT; VORAPAXAR; TRENDS; PROGNOSTICATION

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie; Cardiologie et système cardiovasculaire

Etienne Puymirat, Marc P Bonaca, Maxime Fumery, Victoria Tea, Nadia Aissaoui, et al.. Atherothrombotic risk stratification after acute myocardial infarction: the TIMI Risk Score for Secondary Prevention (TRS‐2P) in the light of the FAST‐MI registries. Clinical Cardiology, 2018, 42 (2), pp.227-234. ⟨10.1002/clc.23131⟩. ⟨hal-02899009⟩