1. Risk Assessment in Patients With Diabetes With the TIMI Risk Score for Atherothrombotic Disease.
- Author
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Bergmark, Brian A., Bhatt, Deepak L., Braunwald, Eugene, Morrow, David A., Steg, Ph. Gabriel, Gurmu, Yared, Cahn, Avivit, Mosenzon, Ofri, Raz, Itamar, Bohula, Erin, and Scirica, Benjamin M.
- Subjects
DIABETES risk factors ,TYPE 2 diabetes ,CARDIOVASCULAR diseases risk factors ,THROMBOLYTIC therapy ,MYOCARDIAL infarction ,PEOPLE with diabetes ,PATIENTS - Abstract
OBJECTIVE: Improved risk assessment for patients with type 2 diabetes and elevated cardiovascular (CV) risk is needed. The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P) predicts a gradient of risk in patients with prior myocardial infarction (MI) but has not been evaluated in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: CV event rates were compared by baseline TRS 2°P in 16,488 patients enrolled in SAVORTIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53)with type 2 diabetes and high CV risk or established CV disease. Calibration was tested in the diabetes cohort from the REACH (REduction of Atherothrombosis for Continued Health) Registry. RESULTS: TRS 2°P revealed a robust risk gradient for the composite of CV death, MI, and ischemic stroke in the full trial population, with 2-year event rates of 0.9% in the lowestand 19.8% in the highest-risk groups (Ptrend < 0.001). A clear risk gradient was present within the subgroups of all coronary artery disease (CAD), CAD without prior MI, CAD with priorMI, peripheral artery disease, and prior stroke (Ptrend < 0.001 for each), with consistent risk relationships across subgroups. The C-statistic (0.71 for CV death and 0.66 for the composite end point) was consistent in each subgroup. There was close calibration with the type 2 diabetes cohort from the REACH Registry (goodness-of-fit P = 0.78). CONCLUSIONS: The expanded TRS 2°P provides a practical and well-calibrated risk prediction tool for patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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