External validation and extension of the TIMI risk score for heart failure in diabetes for patients with recent acute coronary syndrome: An analysis of the EXAMINE trial
Authors' 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.
Study context
- Population
- Patients with T2D and recent acute coronary syndrome in the EXAMINE trial
- Participants
- 5,380 patients
- Comparison
- TRS-HFDM vs TRS-HFDM extended with NT-ProBNP
- Primary endpoint
- Prognostic performance (discrimination and calibration) of the TRS-HFDM for HF hospitalization
Methodological detailsexternal validation, model extension with natriuretic biomarkers, multiple imputation of missing data
- External validation
- Model extension with natriuretic biomarkers
- Multiple imputation of missing data
Primary result
As reported in the abstract
- C-index before model extension
- 0.76 (95% CI 0.73-0.80)
- Calibration slope before model extension
- 0.82 (95% CI 0.65-1.0)
- Calibration-in-the-large before model extension
- −0.15 (95% CI −0.37-0.64)
- C-index after extension with NT-ProBNP
- 0.82 (95% CI 0.79-0.85)
- Calibration slope after extension with NT-ProBNP
- 0.84 (95% CI 0.66-1.02)
- Calibration-in-the-large after extension with NT-ProBNP
- −0.12 (95% CI −0.33-0.081)
Further findings
Heart Failure (HF) hospitalization
- HF hospitalization, all patients
- 193 (3.6%)
TRS-HFDM risk categories
- Intermediate risk (1 point)
- 25%
- High risk (2 points)
- 30%
- Very-high risk (3 points)
- 19%
- Severe risk (≥4 points)
- 26%
Original publication
External validation and extension of the TIMI risk score for heart failure in diabetes for patients with recent acute coronary syndrome: An analysis of the EXAMINE trial. Diabetes Obes Metab. Published 29 September 2022. doi:10.
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