TY - JOUR
T1 - Atherothrombotic risk stratification after acute myocardial infarction
T2 - 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
AU - for the FAST-MI investigators
AU - Puymirat, Etienne
AU - Bonaca, Marc
AU - Fumery, Maxime
AU - Tea, Victoria
AU - Aissaoui, Nadia
AU - Lemesles, Gilles
AU - Bonello, Laurent
AU - Ducrocq, Grégory
AU - Cayla, Guillaume
AU - Ferrières, Jean
AU - Schiele, François
AU - Simon, Tabassome
AU - Danchin, Nicolas
N1 - Publisher Copyright:
© 2018 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
PY - 2019/2
Y1 - 2019/2
N2 - 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.
AB - 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.
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U2 - 10.1002/clc.23131
DO - 10.1002/clc.23131
M3 - Article
C2 - 30536449
AN - SCOPUS:85059131605
SN - 0160-9289
VL - 42
SP - 227
EP - 234
JO - Clinical Cardiology
JF - Clinical Cardiology
IS - 2
ER -