This study describes the study on several patients from selected time period to assess the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS?2P) which has been strongly used to characterize long?term risk in patients.
Three nationwide French registries were conducted 5 years apart over a 10?year period (2005?2015). Briefly, the primary objectives were to evaluate the characteristics, management, and outcomes of AMI patients, as seen in routine clinical practice, on a country?wide scale. All registries consecutively included patients with ST?elevation myocardial infarction (STEMI) or non?ST?elevation myocardial infarction (NSTEMI) admitted to cardiac intensive care units (ICUs) within 48 hours of symptom onset, during a specified 1?month period.
AMI was defined by increased levels of cardiac biomarkers (troponins, creatine kinase (CK), or creatine kinase?MB (CK?MB)) together with either compatible symptoms or electrocardiography (ECG) changes. Patients who died soon after admission and for whom cardiac markers were not measured were included if they had signs or symptoms associated with typical ST?segment changes.
Data on baseline characteristics, including demographics (age, sex, body mass index), risk factors (hypertension, diabetes, current smoking, hypercholesterolemia, family history of coronary artery disease), and medical history (MI, previous myocardial revascularization, stroke, heart failure, peripheral artery disease [PAD], chronic renal failure), were collected.
A total of 12 715 patients had all nine variables included in the TRS?2P score available at discharge. The prevalence of Groups 1, 2, and 3 was 43%, 24%, and 33%, respectively. Over the 10?year period, the overall risk of patients admitted for AMI decreased, with the proportion in Group 3 declining from 43% to 29%. TRS?2P successfully defined patients with high?, intermediate?, and low?CV risk profiles. In addition, the risk for major bleeding defined by the CRUSADE score decreased from Group 3 to Group 1.
The rate of STEMI patients was higher in Group 1, while the rate of patients with heart failure at admission (Killip class ≥ 2) was higher in Group 3. Interestingly, biomarkers of inflammation (eg, C?reactive protein) increased from Group 1 to Group 3.
Early management including medications and myocardial revascularization was significantly different according to TRS?2P categories. Overall, Group 3 patients received fewer antiplatelet agents, statin, beta?blocker, ACE?I, or ARB during the first 48 hours after admission as at discharge compared with both Groups 1 and 2. In Group 3 patients, the use of appropriate secondary prevention treatment was lower especially in patients with renal dysfunction and older patients.
In addition, the use of invasive strategy (coronary angiography with or without PCI) was lower in Group 3, in which the rate of multivessel disease was higher. Radial access was preferentially used in low? or intermediate?risk patients. Finally, a full myocardial revascularization strategy during hospitalization was more frequently used in both Groups 1 and 2.
The rate of re?MI, atrial fibrillation, stroke, and major and minor bleedings were higher in Group 3 patients. Mortality at 30 days was 9% in Group 3, 3% in Group 2, and 1% in Group 1TRS 2P score successfully defined residual risk of death at 1 year, (1?year survival was 98% in Group 1, 94% in Group 2, and 78.5% in Group 3. Using Cox multivariate analysis, Group 3 and Group 2 were associated with a higher risk of death at 1?year. Similar trends were found after censoring patients dying during hospitalization.
Atherothrombotic risk assessment maybe useful to identify high?risk patients who have the greatest potential to benefit from more intensive secondary preventive therapy. Using a routine?practice population, 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.