{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T20:31:48Z","timestamp":1771360308086,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with myocardial infarction (MI) are at increased risk for recurrent cardiovascular events, yet some patients, such as the elderly and those with prior comorbidities, are particularly at the highest risk. Whether these patients benefit from contemporary management is not fully elucidated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Included were consecutive patients with MI who underwent percutaneous coronary intervention (PCI) in a large tertiary medical center. Patients were stratified according to the thrombolysis in myocardial infarction (TIMI) risk score for secondary prevention (TRS2\u00b0P) to high (TRS2\u00b0P\u00a0=\u00a03), very high (TRS2\u00b0P\u00a0=\u00a04), or extremely high\u2010risk (TRS2\u00b0P\u00a0=\u00a05\u20139). Excluded were low and intermediate\u2010risk patients (TRS2\u00b0P\u2009&lt;\u20093). Outcomes included 30\u2010day\/1\u2010year major adverse cardiac events (MACE) and 1\u2010year mortality. Temporal trends were examined in the early (2004\u20132010) and late (2011\u20132016) time\u2010periods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2053 patients, 50% were high\u2010risk, 30% very high\u2010risk and 20% extremely high\u2010risk. Extremely high\u2010risk patients were older (age 74\u2009\u00b1\u200910\u2009year) and had significant comorbidities (chronic kidney disease 68%, prior CABG 40%, heart failure 78%, peripheral artery disease 29%). Drug\u2010eluting stents and potent antiplatelets were more commonly used over time in all risk\u2010strata. Over time, 30\u2010day MACE rates have decreased, mainly attributed to the very high (11.3% to 5.1%, <jats:italic>p<\/jats:italic>\u00a0=\u2009.006) and extremely high\u2010risk groups (15.9% to 8.0%, <jats:italic>p<\/jats:italic>\u00a0=\u2009.016), but not the high\u2010risk group, with similar quantitative results for 1\u2010year MACE. The rates of 1\u2010year mortality remained unchanged in either group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Within a particularly high\u2010risk cohort of MI patients who underwent PCI, the implementation of guideline\u2010recommended therapies has improved over time, with the highest\u2010risk groups demonstrating the greatest benefit in outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23715","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T14:48:28Z","timestamp":1630507708000},"page":"1535-1542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Management and outcome across the spectrum of high\u2010risk patients with myocardial infarction according to the thrmobolysis in myocardial infarction (TIMI) risk\u2010score for secondary prevention"],"prefix":"10.1002","volume":"44","author":[{"given":"Tzlil","family":"Grinberg","sequence":"first","affiliation":[{"name":"Department of Cardiology Rabin Medical Center  Petah Tikva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamir","family":"Bental","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center  Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoav","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center  Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abid","family":"Assali","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center  Petah Tikva Israel"},{"name":"Sackler Faculty of 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