Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting
BackgroundThe 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). W...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008661 |
| _version_ | 1828888645287804928 |
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| author | Sameer Arora Paula D. Strassle Arman Qamar Evan N. Wheeler Alexandra L. Levine Jacob A. Misenheimer Matthew A. Cavender George A. Stouffer Prashant Kaul |
| author_facet | Sameer Arora Paula D. Strassle Arman Qamar Evan N. Wheeler Alexandra L. Levine Jacob A. Misenheimer Matthew A. Cavender George A. Stouffer Prashant Kaul |
| author_sort | Sameer Arora |
| collection | DOAJ |
| description | BackgroundThe 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 ResultsWe 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). ConclusionsNSTEMI 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. |
| first_indexed | 2024-12-13T12:26:15Z |
| format | Article |
| id | doaj.art-45ec029b80b44b1bbcd2633f8f7891dc |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T12:26:15Z |
| publishDate | 2018-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-45ec029b80b44b1bbcd2633f8f7891dc2022-12-21T23:46:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-04-017710.1161/JAHA.118.008661Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public ReportingSameer Arora0Paula D. Strassle1Arman Qamar2Evan N. Wheeler3Alexandra L. Levine4Jacob A. Misenheimer5Matthew A. Cavender6George A. Stouffer7Prashant Kaul8Division of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NCDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NCDivision of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MACampbell University School of Osteopathic Medicine, Lillington, NCCampbell University School of Osteopathic Medicine, Lillington, NCDivision of Cardiology, Medical College of Georgia at Augusta University, Augusta, GADivision of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NCDivision of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NCDivision of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NCBackgroundThe 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 ResultsWe 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). ConclusionsNSTEMI 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.https://www.ahajournals.org/doi/10.1161/JAHA.118.008661coronary artery diseasemortalitymyocardial infarctionreadmissiontroponin |
| spellingShingle | Sameer Arora Paula D. Strassle Arman Qamar Evan N. Wheeler Alexandra L. Levine Jacob A. Misenheimer Matthew A. Cavender George A. Stouffer Prashant Kaul Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary artery disease mortality myocardial infarction readmission troponin |
| title | Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting |
| title_full | Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting |
| title_fullStr | Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting |
| title_full_unstemmed | Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting |
| title_short | Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting |
| title_sort | impact of type 2 myocardial infarction mi on hospital level mi outcomes implications for quality and public reporting |
| topic | coronary artery disease mortality myocardial infarction readmission troponin |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008661 |
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