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

7 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.
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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.",
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T2 - Implications for quality and public reporting

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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

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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

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