Geisinger Health System, Danville, PA, USA.
Cleveland Clinic, Cleveland, OH, USA.
Atherosclerosis. 2018 May;272:80-86. doi: 10.1016/j.atherosclerosis.2018.03.026. Epub 2018 Mar 16.
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.
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.
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.
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.
对近期心肌梗死（MI）患者进行心血管（CV）事件的风险分层有助于确定最有可能从二级预防治疗中获益的患者。本研究在克利夫兰诊所（CC）和 Geisinger 健康系统（GHS）的两个大型医疗保健系统中，对来自 TRA2°P-TIMI 50 试验的近期 MI 患者进行了一项新的二级事件风险评分（TRS2˚P）的外部验证。
本回顾性队列研究纳入了 2008 年至 2013 年间在 CC 或 GHS 接受急性 MI 治疗的 9618 例患者。纳入 MI 后 2-52 周内有门诊就诊记录的患者，并通过电子病历（EMR）随访 CV 死亡、再次 MI 和缺血性卒中。TRS2˚P 基于通过 EMR 记录确定的九个因素。在两个患者群体中均对 TRS2˚P 的区分度和校准度进行了量化。
与 TRA2°P-TIMI 50 试验相比，CC 和 GHS 的 MI 患者年龄更大、合并症更多、接受的药物治疗更少，且 3 年事件发生率更高：31%（CC）、33%（GHS）和 10%（TRA2°P-TIMI 50）。该风险评分在三个队列中的区分度相似，C 统计量分别为 0.66（CC）、0.66（GHS）和 0.67（TRA2°P-TIMI 50）。在所有队列中均观察到风险评分与事件发生率之间呈强梯度关系，但在 CC 和 GHS 队列中，TRS2˚P 各分层的 3 年事件发生率始终高于 TRA2°P-TIMI 50。
TRS2˚P 在近期 MI 的试验和非试验患者中均表现出一致的风险区分度，但非试验队列的事件发生率始终较高。
