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Long-term risk stratification of patients undergoing coronary angiography according to the TIMI risk score for secondary prevention

Session Assessment of residual risk after percutaneous coronary intervention

Speaker Assistant Professor Barak Zafrir

Congress : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease - Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters
  • FP Number : P1253

Authors : B Zafrir (Haifa,IL), S Adawi (Haifa,IL), M Khalaily (Haifa,IL), R Jaffe (Haifa,IL), A Eitan (Haifa,IL), W Saliba (Haifa,IL)

B Zafrir1 , S Adawi1 , M Khalaily1 , R Jaffe1 , A Eitan1 , W Saliba2 , 1Lady Davis Carmel Medical Center, Cardiology Department - Haifa - Israel , 2Lady Davis Carmel Medical Center, Community Medicine and Epidemiology - Haifa - Israel ,


Background: A risk score for secondary prevention after myocardial infarction (TRS2P) was recently developed from the TRA2°P-TIMI50 trial based on 9 established clinical factors [age=75, hypertension, diabetes, smoking, kidney dysfunction, peripheral artery disease, heart failure, prior stroke and prior coronary artery-bypass surgery (CABG)], classifying the risk for major adverse cardiovascular events (MACE). We aimed to evaluate the performance of TRS2P for predicting long-term outcomes in real-world patients presenting for coronary angiography.

Methods: Retrospective analysis of 13,593 patients that were referred to angiography for the assessment or treatment of coronary artery disease between 2000-2015 in a single center. Risk stratification for 10-year MACE (myocardial infarction, ischemic stroke or all-cause death) was performed using the TRS2P score, divided into 6 categories (0 to =5 points), and in relation to the presenting coronary syndrome.

Results: All clinical variables, except of prior CABG, were independent risk predictors. The annualized incidence rate of MACE increased in a graded manner with increasing TRS2P score, ranging from 1.65 to 16.6 per 100 person-years (ptrend<0.001). The pattern was similar for 10-year cumulative incidence of MACE. Compared to the lowest-risk group (risk indicators=0), the hazard-ratios (95% confidence interval) for MACE were 1.60 (1.36-1.89), 2.58 (2.21-3.02), 4.31 (3.69-5.05), 6.43 (5.47-7.56) and 10.03 (8.52-11.81), in those with 1,2,3,4 and =5 risk indicators, respectively. Risk gradation was consistent across the individual clinical endpoints. TRS2P score showed reasonable discrimination with c-statistics of 0.704 for MACE and 0.735 for mortality. The graded relationship between the risk score and event rates was observed in both patients presenting with acute and non-acute coronary syndromes.

Conclusions: The use of TRS2P, a simple risk score based on routinely collected variables, enables risk stratification in patients undergoing coronary angiography. Its predictive value was demonstrated in real-world setting with long-term follow-up, and irrespective of the acuity of coronary presentation.

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