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

Abstract

Background: Patients who survive non-ST-elevation myocardial infarction (NSTEMI) 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-NSTEMI 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 postNSTEMI patients. Methods: This was an observational study that applied the TRS 2°P score to a consecutive cohort of 891 post-NSTEMI patients (73.7±12.7 years; male: 54.2%). 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 39.1±34.1 months, 281 patients (31.5%) had developed a primary outcome (13.3%/year) including 196 cardiovascular deaths, 94 non-fatal MIs, and 22 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 1.6%, and increased progressively to 47.4% for those with TRS 2°P score ≥6 (HR: 20.18, 95% CI: 4.85–84.05, p<0.001). Similar associations were also observed between the TRS 2°P score and cardiovascular death and MI (fetal and non-fatal), but not non-fatal ischemic stroke. Conclusion: The TRS 2°P reliably stratified post-NSTEMI patients for risk of future cardiovascular events and might help guide the selection of more aggressive therapy such as monoclonal antibody to PCSK9.