Atherothrombotic risk stratification after acute myocardial infarction: The TIMI Risk Score for Secondary Prevention (TRS-2P) in the light of the FAST-MI registries

Background Guidelines recommend risk stratification tools for use in acute myocardial infarction (AMI) to assist decisions making. Few tools are, however, available to assist with decisions on long-term response to treatment. Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) has been recently propose for this indication. Aim We aimed to assess the TRS-2P and to identify high-risk patients after AMI in the FAST-MI registries. Methods We used data from 3 one-month French registries, conducted 5 years apart, from 2005 to 2015, including 13,130 patients with AMI [52% ST-elevation myocardial infarction (STEMI)] admitted to cardiac intensive care units. Atherothrombotic risk stratification was performed using the TRS-2P score. Patients were divided in 3 categories: G1 (Low-risk; TRS-2P = 0/1); G2 (Intermediate-risk; TRS-2P = 2); and, G3 (High-risk; TRS-2P ≥ 3). Baseline characteristics and outcomes were analyzed according to TRS-2P categories. Results A total of 12,715 patients (in whom TRS-2P was available) were included in this analysis. Prevalence of G1, G2, and G3 was 43%, 24% and 33% respectively. Clinical characteristics and management significantly differ according to TRS-2P categories. TRS-2P score successfully defined residual risk of death at one-year (C-statistic 0.78): 1-year survival was 98% in G1, 94% in G2, and 78.5% in G3 ( P Conclusions The 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.