External validation and extension of the <scp>TIMI</scp> risk score for heart failure in diabetes for patients with recent acute coronary syndrome: An analysis of the <scp>EXAMINE</scp> trial
Diabetes, Obesity and Metabolism, 2022
Razaghizad A., Sharma A., Ni J., Ferreira J., White W., Mehta C., Bakris G., Zannad F.
| Disease area | Application area | Sample type | Products |
|---|---|---|---|
CVD | Patient Stratification | Plasma |  Olink Target 96 |
Abstract
Aims
The Thrombolysis in Myocardial Infarction Risk Score for Heart Failure (HF) in Diabetes (TRS‐HFDM) prognosticates HF hospitalization in people with type 2 diabetes (T2D). This study aimed to externally validate and extend its use for those with recent acute coronary syndrome (ACS).
Materials and Methods
The TRS‐HFDM was externally validated in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial (n = 5380) and extended with natriuretic biomarkers. Missing data were multiply imputed. Initial TRS‐HFDM variables were previous HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 ml/min/1.73 m2 (1 point), and urine albumin‐to‐creatinine ratio 30‐300 mg/g (1 point) and >300 mg/g (2 points).
Results
In total, HF hospitalization occurred in 193 (3.6%) patients. Based on the TRS‐HFDM, 25% of patients were classified as intermediate risk (1 point), 30% were classified as high risk (2 points), 19% were classified as very‐high risk (3 points) and 26% were classified as severe risk (≥4 points). Before model extension, discrimination (C‐index 0.76, 95%·CI 0.73‐0.80) and calibration (calibration slope 0.82, 95%·CI 0.65‐1.0; calibration‐in‐the‐large −0.15, 95%·CI −0.37‐0.64) were moderate‐to‐good in individuals with T2D and recent ACS. The extension of TRS‐HFDM with the addition of N‐terminal pro‐B‐type natriuretic peptide (NT‐ProBNP) improved discrimination (C‐index 0.82, 95%·CI 0.79‐0.85) and calibration (calibration slope 0.84, 95%·CI 0.66‐1.02; calibration‐in‐the‐large −0.12, 95%·CI −0.33‐0.081) for this higher‐risk population.
Conclusion
The TRS‐HFDM with the extension of NT‐ProBNP improves risk stratification and generalizes the use of the risk score for patients with T2D and ACS. Future validation studies in ACS populations may be warranted.