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 SAVOR-TIMI 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 lowest- and 19.8% in the highest-risk groups (P_trend < 0.001). A clear risk gradient was present within the subgroups of all coronary artery disease (CAD), CAD without prior MI, CAD with prior MI, peripheral artery disease, and prior stroke (P_trend < 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.

目的需要改善2型糖尿病和心血管（CV）风险患者的风险评估。二级预防的心肌梗塞溶栓（TIMI）风险评分（TRS 2°P）可以预测先前有心肌梗塞（MI）的患者的风险梯度，但尚未对2型糖尿病患者进行评估。

研究设计和方法通过基线TRS 2°P比较了SAVOR-TIMI 53（2型糖尿病和高CV的SAVOR-TIMI 53（糖尿病患者的萨格列汀评估的心肌梗塞记录的血管结局评估53）中的心血管事件发生率）风险或已确定的心血管疾病。在REACH（减少持续性血栓形成）注册中心的糖尿病队列中对校准进行了测试。

结果TRS 2°P揭示了在整个试验人群中心血管死亡，心肌梗死和缺血性卒中的复合风险稳健性，最低风险组的2年事件发生率分别为0.9％和19.8％。 （P_趋势<0.001）。所有冠状动脉疾病（CAD），无先前MI的CAD，具有先前MI的CAD，周围动脉疾病和先前中风的亚组内均存在明确的风险梯度（各组的P_趋势<0.001），各亚组之间的风险关系一致。在每个亚组中，C统计量（CV死亡为0.71，复合终点为0.66）是一致的。REACH注册中心对2型糖尿病队列进行了密切校正（拟合优度P = 0.78）。

结论扩展的TRS 2°P为2型糖尿病患者提供了一种实用且经过良好校准的风险预测工具。