Atherosclerotic cardiovascular disease is currently one of the most common causes of morbidity and mortality worldwide.1 Despite the advances in management of atherosclerotic cardiovascular disease, the prevalence is expected to increase in the coming decades due to aging population and increasing industrialisation. Patients surviving a major cardiovascular event such as myocardial infarction (MI) are considered at the highest risk of future occurrence of major cardiovascular events, thereby should be treated very aggressively.

However, the risk of future cardiovascular events such as recurrent MI, stroke and cardiovascular death in patients surviving MI is not uniform and varies widely across different patients. Unlike primary prevention, in which several cardiovascular risk-stratification schemes such as Framingham risk score, the SCORE, and QRISK, are currently available to guide long-term clinical decisions, existing risk stratification models for in secondary prevention such as in patients with recent acute coronary syndrome focusing largely on short term prognostication do not assist long-term therapeutic decision making.

Recently, the Thrombolysis In Myocardial Infarction (TIMI) group has developed a simple 9-point risk stratification tool to predict recurrent cardiovascular events using data from the Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events, Thrombolysis In Myocardial Infarction (TIMI) 50 trial involving stable patients with previous MI. This TIMI Risk Score for Secondary Prevention (TRS 2°P) score incorporates 9 readily available clinical characteristics: congestive heart failure, hypertension, diabetes mellitus, age ≥75 years, prior stroke, prior coronary artery bypass graft, peripheral artery disease, estimated glomerular filtration rate