Pinesi Henrique Trombini, Moreira Eduardo Martelli, Barbosa Marcelo Henrique Moreira, Pitta Fabio Grunspun, Rached Fabiana Hanna, Lima Eduardo Gomes, Martins Eduardo Bello, Serrano Carlos Vicente
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Hospital Israelita Albert Einstein, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2025 Apr;122(5):e20240821. doi: 10.36660/abc.20240821.
Risk stratification in chronic coronary syndrome (CCS) patients is challenging. TIMI Risk Score for Secondary Prevention (TRS2P) is a simple nine-point tool developed to predict cardiovascular death, myocardial infarction (MI), and ischemic stroke among post-MI patients. No studies have been conducted on it in the Brazilian population.
Validate the TRS2P score among CCS patients at a tertiary center in Brazil.
This is a registry-based study of patients with CCS, defined as having a previous revascularization procedure, previous MI, or ≥50% stenosis in at least one epicardial coronary artery. The primary outcome was the three-year incidence of MACE (death, MI or stroke). The predicted risk was as reported in the original derivation study. Calibration was assessed through a calibration plot and the Hosmer-Lemeshow test. Discrimination was evaluated through the concordance (C)-statistic. A significance level of 0.05 was adopted.
The study sample consisted of 515 patients. There were 173 (34%) women, 75 (15%) aged over 75 years, 298 (58%) had diabetes, and 156 (30%) had chronic kidney disease. During follow-up, 126 MACE were documented. The estimated three-year incidence was 24% (95% confidence interval [CI] 21%-28%), whereas the predicted incidence was 15%. Although higher TRS2P scores were associated with higher MACE incidence, the TRS2P risk score model underestimated MACE incidence at every strata (p < 0.01). The C-statistic was 0.64 (95% CI 0.58-0.69).
The TRS2P score identifies patients with a higher risk of cardiovascular events but it underestimated MACE and presented poor discrimination in a Brazilian CCS cohort.
慢性冠状动脉综合征（CCS）患者的风险分层具有挑战性。二级预防的TIMI风险评分（TRS2P）是一种简单的九点工具，用于预测心肌梗死后患者的心血管死亡、心肌梗死（MI）和缺血性卒中。巴西人群中尚未对其进行研究。
在巴西一家三级中心验证CCS患者的TRS2P评分。
这是一项基于登记的CCS患者研究，CCS定义为既往有血运重建手术、既往心肌梗死或至少一条心外膜冠状动脉狭窄≥50%。主要结局是主要不良心血管事件（MACE，死亡、心肌梗死或卒中）的三年发生率。预测风险如原始推导研究中所报告。通过校准图和Hosmer-Lemeshow检验评估校准情况。通过一致性（C）统计量评估辨别力。采用0.05的显著性水平。
研究样本包括515例患者。其中女性173例（34%），75岁以上者75例（15%），糖尿病患者298例（58%），慢性肾脏病患者156例（30%）。随访期间，记录到126例MACE。估计三年发生率为24%（95%置信区间[CI] 21%-28%），而预测发生率为15%。尽管较高的TRS2P评分与较高的MACE发生率相关，但TRS2P风险评分模型在每个分层中均低估了MACE发生率（p < 0.01）。C统计量为0.64（95% CI 0.58-0.69）。
TRS2P评分可识别心血管事件风险较高的患者，但在巴西CCS队列中，它低估了MACE且辨别力较差。
