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

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.

Cardiovascular Risk Factors and Secondary Events Among Acute and Chronic Stable Myocardial Infarction Patients: Findings from a Managed Care Database

“…The short-term prognosis following MI among acute patients is worse than those who reach the chronic stable phase of atherosclerotic disease. This finding is consistent with several recent studies demonstrating higher acute risk versus lower long-term risk [8,[19][20][21][22]. However, few studies have reported the risk factors associated with relatively long-term clinical endpoints between acute and chronic stable MI patients [9,10].…”

Environmental noise exposure is associated with atherothrombotic risk

“…1 ). TRS-2P was developed in a large population with atherothrombosis to predict recurrent CV events 12 and has been validated in various populations to characterize long-term risk after recent acute MI 13 , 14 . The TRS-2P score ranges from 0 to 9 and was split for more risk classification relevance, into 4 classes of atherothrombotic risk namely: low-risk (TRS-2P = 0/1), medium–low-risk (TRS-2P = 2), medium–high-risk (TRS-2P = 3) and high-risk (TRS-2P ≥ 4).…”

Untargeted high-resolution plasma metabolomic profiling predicts outcomes in patients with coronary artery disease

“…[2] This risk score consists of nine easily measurable clinical variables (age, current smoking, hypertension, diabetes, heart failure, stroke, prior coronary artery bypass grafting, peripheral artery disease, and chronic kidney disease) and has been shown to perform well in external validation studies. [78,79] However, this approach does not identify individual plasma metabolites or the dysregulated metabolic pathways associated with mortality in this high-risk patient population. In addition to identifying the six significant metabolic pathways described above, we identified a unique subset of seven metabolites was identified using stringent statistical criteria and these were used to create a novel metabolomic risk score.…”