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Objective: The TIMI Risk Score for secondary prevention (TRS2°P), a simple scoring system based on presence/absence of nine clinical factors, was developed to stratify the risk of secondary events in patients with a history of myocardial infarction (MI), but its performance has not been evaluated in patients with peripheral artery disease (PAD). Since MI and PAD are caused by similar biology and underlying atherosclerotic disease it is possible that TRS2°P is also informative in PAD patients. Methods: TRS2°P was calculated with a point value of 1 assigned for heart failure, hypertension, age ≥75 years, diabetes, stroke, coronary artery bypass graft, PAD, kidney dysfunction, and current smoking (since all patients had PAD, the lowest possible score was 1). We evaluated prediction statistics of TRS2°P for major adverse cardiovascular disease (MACE) (a composite of cardiovascular death, myocardial infarction, or ischemic stroke) in 386,458 patients with PAD in five international cohorts from New Zealand, South Korea, Sweden, and the US participating in the Chronic Kidney Disease Prognosis Consortium. Results: Overall, there were 134,827 cases of MACE outcomes reported across five cohorts over a mean follow-up of 5 years, and overall MACE rate ranged from 1.5 to 8.6 (per 100 person-years). The TRS2°P showed modest calibration (Brier score ranged from 0.061 to 0.160) and discrimination (c-statistics ranged from 0.59 to 0.69) across cohorts (Brier score was 0.098 and c-statistic was 0.67 in the TRS2°P derived dataset). Although there was some heterogeneity across cohorts, the predictors in the TRS2°P were generally associated with MACE in patients with PAD, with the strongest association for a history of heart failure (meta-analyzed adjusted hazard ratio [HR] 2.1), followed by age ≥75 years (HR 1.8), stroke (HR 1.7), kidney dysfunction (HR 1.4), and current smoking (HR 1.2). Hypertension and coronary artery bypass graft surgery did not reach statistical significance. Conclusion: TRS2°P was reasonably predictive of MACE outcomes when applied in patients with PAD and thus can be a reasonable tool for risk assessment in two common leading atherosclerotic diseases, MI and PAD. [ABSTRACT FROM AUTHOR]

Background: The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS2°P), a 0-to-9-point system based on the presence/absence of 9 clinical factors, was developed to classify the risk of major adverse cardiovascular events (MACE) (a composite of cardiovascular death, recurrent myocardial infarction, or ischemic stroke) among patients with a recent myocardial infarction. Its performance has not been examined internationally outside of a clinical trial setting., Methods and Results: We evaluated the performance of TRS2°P for predicting MACE in 53 599 patients with recent myocardial infarction in 5 international cohorts from New Zealand, South Korea, Sweden, and the United States participating in the Chronic Kidney Disease Prognosis Consortium. Overall, there were 19 444 cases of MACE across 5 cohorts over a mean follow-up of 5 years, and the overall MACE rate ranged from 5.0 to 18.4 (per 100 person-years). The TRS2°P showed modest calibration (Brier score ranged from 0.144 to 0.173) and discrimination (C-statistics >0.61 in all studies except 1 from Korea with 0.55) across cohorts relative to its original Brier score of 0.098 and C-statistic of 0.67 in the derived data set. Although there was some heterogeneity across cohorts, the 9 predictors in the TRS2°P were generally associated with higher MACE risk, with strongest associations observed (meta-analyzed adjusted hazard ratio 1.6-1.7) for history of heart failure, age ≥75 years, and prior stroke, followed by peripheral artery disease, kidney dysfunction, diabetes mellitus, and hypertension (hazard ratio 1.3-1.4). Prior coronary bypass graft surgery and smoking did not reach statistical significance (hazard ratio ≈1.1)., Conclusions: TRS2°P, a simple scoring system with 9 routine clinical factors, was modestly predictive of secondary events when applied in patients with recent myocardial infarction from diverse clinical and geographic settings., (© 2018 The Authors and Merck Sharpe & Dohme Corp. Published on behalf of the American Heart Association, Inc., by Wiley.)