Risk Assessment in Patients With Diabetes With the TIMI Risk Score for Atherothrombotic Disease

Area of Science:

• Cardiology
• Endocrinology
• Clinical Risk Assessment

Background:

• Patients with type 2 diabetes and elevated cardiovascular (CV) risk require improved risk assessment tools.
• The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P) is established for post-myocardial infarction (MI) risk stratification but unproven in type 2 diabetes.
• The SAVOR-TIMI 53 trial provides a large dataset of patients with type 2 diabetes and high CV risk.

Purpose of the Study:

• To evaluate the effectiveness of the TRS 2°P in predicting cardiovascular events in patients with type 2 diabetes.
• To assess the calibration and risk stratification capabilities of the TRS 2°P in this specific population.
• To determine if the TRS 2°P provides a gradient of risk across various cardiovascular subgroups.

Main Methods:

• Analysis of 16,488 patients from the SAVOR-TIMI 53 trial with type 2 diabetes and high CV risk or established CV disease.
• Comparison of CV event rates stratified by baseline TRS 2°P.
• Calibration testing using the type 2 diabetes cohort from the REACH Registry.

Main Results:

• The TRS 2°P demonstrated a robust risk gradient for the composite of CV death, MI, and ischemic stroke (2-year event rates from 0.9% to 19.8%).
• A clear risk gradient was consistently observed across subgroups including coronary artery disease (CAD), CAD without prior MI, CAD with prior MI, peripheral artery disease, and prior stroke.
• The score showed good calibration within the type 2 diabetes population (goodness-of-fit P = 0.78) and consistent predictive performance (C-statistics 0.71 for CV death, 0.66 for composite endpoint).

Conclusions:

• The expanded TRS 2°P serves as a practical and well-calibrated risk prediction tool for patients with type 2 diabetes.
• This score can aid clinicians in identifying individuals at higher cardiovascular risk within this population.
• The findings support the utility of the TRS 2°P for enhanced cardiovascular risk assessment in type 2 diabetes management.