External validation of the TIMI risk score for secondary cardiovascular events among patients with recent myocardial infarction

Brent A. Williams, Kevin M. Chagin, Lori D. Bash, William E. Boden, Sue Duval, F. Gerry R. Fowkes, Kenneth W. Mahaffey, Mehul D. Patel, Ralph B. D'Agostino, Eric D. Peterson, Michael W. Kattan, Deepak L. Bhatt, Marc P. Bonaca

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background and aims: Risk stratification of patients with recent myocardial infarction (MI) for subsequent cardiovascular (CV) events helps identify patients most likely to benefit from secondary prevention therapies. This study externally validated a new risk score (TRS2˚P) for secondary events derived from the TRA2°P-TIMI 50 trial among post-MI patients from two large health care systems. Methods: This retrospective cohort study included 9618 patients treated for acute MI at either the Cleveland Clinic (CC) or Geisinger Health System (GHS) between 2008 and 2013. Patients with a clinic visit within 2–52 weeks of MI were included and followed for CV death, repeat MI, and ischemic stroke through electronic medical records (EMR). The TRS2˚P is based on nine factors determined through EMR documentation. Discrimination and calibration of the TRS2˚P were quantified in both patient populations. Results: MI patients at CC and GHS were older, had more comorbidities, received fewer medications, and had higher 3-year event rates compared to subjects in the TRA2°P trial: 31% (CC), 33% (GHS), and 10% (TRA2°P-TIMI 50). The proposed risk score had similar discrimination across the three cohorts with c-statistics of 0.66 (CC), 0.66 (GHS), and 0.67 (TRA2°P-TIMI 50). A strong graded relationship between the risk score and event rates was observed in all cohorts, though 3-year event rates were consistently higher within TRS2°P strata in the CC and GHS cohorts relative to TRA2˚P-TIMI 50. Conclusions: The TRS2˚P demonstrated consistent risk discrimination across trial and non-trial patients with recent MI, but event rates were consistently higher in the non-trial cohorts.

Original languageEnglish (US)
Pages (from-to)80-86
Number of pages7
StatePublished - May 2018

Bibliographical note

Funding Information:
Dr. Bhatt reports grants from Amarin , AstraZeneca , Bristol-Myers Squibb , Eisai , Ethicon , Medtronic , sanofi aventis , The Medicines Company , FlowCo ; other fees from PLx Pharma, Takeda, and Duke Clinical Research Institute; personal fees from Mayo Clinic, Population Health Research Institute, American College of Cardiology, Belvoir Publications, Slack Publications, WebMD, Elsevier, Medscape Cardiology, Regado Biosciences, Boston VA Research Institute, personal fees and non-financial support from Society of Cardiovascular Patient Care, non-financial support from American Heart Association, personal fees from HMP Communications, grants from Roche , personal fees from Harvard Clinical Research Institute, other from Clinical Cardiology, personal fees from Journal of the American College of Cardiology, other from VA, grants from Pfizer , grants from Forest Laboratories/AstraZeneca , grants from Ischemix , other from St. Jude Medical (now Abbott), other from Biotronik, other from Cardax, other from American College of Cardiology, other from Boston Scientific, grants from Amgen , grants from Lilly , grants from Chiesi , grants from Ironwood , personal fees from Cleveland Clinic, personal fees from Mount Sinai School of Medicine, other from Merck, grants from Abbott , grants from Regeneron , outside the submitted work.

Funding Information:
This work was supported by Merck & Co., Inc. , Kenilworth, NJ, USA, through research agreements with the Geisinger Health System and the Cleveland Clinic Foundation. The Scientific Committee received consultation fees from Merck & Co. Inc., Kenilworth, NJ, USA.

Publisher Copyright:
© 2018

Copyright 2018 Elsevier B.V., All rights reserved.


  • Electronic medical record
  • Myocardial infarction
  • Risk stratification
  • Secondary prevention


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