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


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
Pages (from-to)80-86
Number of pages7
Early online date16 Mar 2018
Publication statusE-pub ahead of print - 16 Mar 2018


  • Journal Article


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