Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes: Implications for quality and public reporting

Sameer Arora, Paula D. Strassle, Arman Qamar, Evan N. Wheeler, Alexandra L. Levine, Jacob A. Misenheimer, Matthew A. Cavender, George A. Stouffer, Prashant Kaul

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background--The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment- elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. Methods and Results--We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4% versus 4.7%, P < 0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%, P < 0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95% confidence interval, 0.12-2.06). Conclusions--NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics.

Original languageEnglish (US)
Article numbere008661
JournalJournal of the American Heart Association
Volume7
Issue number7
DOIs
StatePublished - Apr 1 2018

Fingerprint

Myocardial Infarction
Mortality
Odds Ratio
Confidence Intervals
Troponin
Patient Discharge
International Classification of Diseases
Chronic Renal Insufficiency
Non-ST Elevated Myocardial Infarction
Inpatients

Keywords

  • Coronary artery disease
  • Mortality
  • Myocardial infarction
  • Readmission
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes : Implications for quality and public reporting. / Arora, Sameer; Strassle, Paula D.; Qamar, Arman; Wheeler, Evan N.; Levine, Alexandra L.; Misenheimer, Jacob A.; Cavender, Matthew A.; Stouffer, George A.; Kaul, Prashant.

In: Journal of the American Heart Association, Vol. 7, No. 7, e008661, 01.04.2018.

Research output: Contribution to journalArticle

Arora, S, Strassle, PD, Qamar, A, Wheeler, EN, Levine, AL, Misenheimer, JA, Cavender, MA, Stouffer, GA & Kaul, P 2018, 'Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes: Implications for quality and public reporting', Journal of the American Heart Association, vol. 7, no. 7, e008661. https://doi.org/10.1161/JAHA.117.008661
Arora, Sameer ; Strassle, Paula D. ; Qamar, Arman ; Wheeler, Evan N. ; Levine, Alexandra L. ; Misenheimer, Jacob A. ; Cavender, Matthew A. ; Stouffer, George A. ; Kaul, Prashant. / Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes : Implications for quality and public reporting. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 7.
@article{f9a0daf308264b4094849afdc68945e4,
title = "Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes: Implications for quality and public reporting",
abstract = "Background--The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment- elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. Methods and Results--We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4{\%}) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4{\%} versus 4.7{\%}, P < 0.0001) and were more likely to die from noncardiovascular causes (71.7{\%} versus 25.0{\%}, P < 0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95{\%} confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95{\%} confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95{\%} confidence interval, 0.12-2.06). Conclusions--NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics.",
keywords = "Coronary artery disease, Mortality, Myocardial infarction, Readmission, Troponin",
author = "Sameer Arora and Strassle, {Paula D.} and Arman Qamar and Wheeler, {Evan N.} and Levine, {Alexandra L.} and Misenheimer, {Jacob A.} and Cavender, {Matthew A.} and Stouffer, {George A.} and Prashant Kaul",
year = "2018",
month = "4",
day = "1",
doi = "10.1161/JAHA.117.008661",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes

T2 - Implications for quality and public reporting

AU - Arora, Sameer

AU - Strassle, Paula D.

AU - Qamar, Arman

AU - Wheeler, Evan N.

AU - Levine, Alexandra L.

AU - Misenheimer, Jacob A.

AU - Cavender, Matthew A.

AU - Stouffer, George A.

AU - Kaul, Prashant

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background--The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment- elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. Methods and Results--We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4% versus 4.7%, P < 0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%, P < 0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95% confidence interval, 0.12-2.06). Conclusions--NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics.

AB - Background--The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment- elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. Methods and Results--We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4% versus 4.7%, P < 0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%, P < 0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95% confidence interval, 0.12-2.06). Conclusions--NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics.

KW - Coronary artery disease

KW - Mortality

KW - Myocardial infarction

KW - Readmission

KW - Troponin

UR - http://www.scopus.com/inward/record.url?scp=85044853471&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044853471&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.008661

DO - 10.1161/JAHA.117.008661

M3 - Article

C2 - 29581221

AN - SCOPUS:85044853471

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 7

M1 - e008661

ER -