Department of Medicine, Massachusetts General Hospital, Boston.
Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut.
JAMA Cardiol. 2019 May 1;4(5):460-464. doi: 10.1001/jamacardio.2019.0716.
Similar to other patients with acute myocardial infarction, patients with type 2 myocardial infarction (T2MI) are included in several value-based programs, including the Hospital Readmissions Reduction Program and the Hospital Value-Based Purchasing Program. To our knowledge, whether nonischemic myocardial injury is being misclassified as T2MI is unknown and may have implications for these programs.
To determine whether patients with nonischemic myocardial injury are being miscoded as having T2MI and if this has implications for 30-day readmission and mortality rates.
DESIGN, SETTINGS, AND PARTICIPANTS: Using the new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code, we identified patients who were coded as having T2MI between October 2017 and May 2018 at Massachusetts General Hospital. Strict adjudication using the fourth universal definition of MI was then applied.
Clinical adjudication of T2MI and 30-day readmission and mortality rates as a function of T2MI or nonischemic myocardial injury.
Of 633 patients, 369 (58.3%) were men and 514 (81.2%) were white. After strict adjudication, 359 (56.7%) had T2MI, 265 (41.9%) had myocardial injury, 6 (0.9%) had type 1 MI, and 3 (0.5%) had unstable angina. Patients with T2MI had a higher prevalence of cardiovascular comorbidities than those with myocardial injury. Patients with T2MI and myocardial injury had high in-hospital mortality rates (10.6% and 8.7%, respectively; P = .50). Of those discharged alive (563 [88.9%]), 30-day readmission rates (22.7% vs 21.1%; P = .68) and mortality rates (4.4% vs 7.4%; P = .14) were comparable among patients with T2MI and myocardial injury.
A substantial percentage of patients coded as having T2MI actually have myocardial injury. Both conditions have high 30-day readmission and mortality rates. Including patients with high-risk myocardial injury may have substantial implications for value-based programs.
与其他急性心肌梗死患者类似，2 型心肌梗死（T2MI）患者被纳入了多项基于价值的计划，包括住院患者再入院率降低计划和医院基于价值的采购计划。据我们所知，非缺血性心肌损伤是否被错误分类为 T2MI 尚不清楚，这可能对这些计划产生影响。
确定是否有非缺血性心肌损伤患者被错误地归类为 T2MI，如果是这样，这是否对 30 天再入院率和死亡率有影响。
设计、地点和参与者：我们使用新的国际疾病分类和相关健康问题第十次修订版代码，确定了 2017 年 10 月至 2018 年 5 月期间马萨诸塞州综合医院被编码为 T2MI 的患者。然后，我们采用第四版心肌梗死的通用定义进行了严格的裁定。
T2MI 的临床裁定以及作为 T2MI 或非缺血性心肌损伤函数的 30 天再入院率和死亡率。
在 633 名患者中，369 名（58.3%）为男性，514 名（81.2%）为白人。经过严格的裁定，359 名（56.7%）患者患有 T2MI，265 名（41.9%）患者患有心肌损伤，6 名（0.9%）患者患有 1 型 MI，3 名（0.5%）患者患有不稳定型心绞痛。患有 T2MI 的患者比患有心肌损伤的患者更常见心血管合并症。患有 T2MI 和心肌损伤的患者住院期间死亡率较高（分别为 10.6%和 8.7%；P = .50）。在那些存活出院的患者中（563 [88.9%]），T2MI 和心肌损伤患者的 30 天再入院率（分别为 22.7%和 21.1%；P = .68）和死亡率（分别为 4.4%和 7.4%；P = .14）相似。
被编码为 T2MI 的患者中有相当大比例的患者实际上患有心肌损伤。这两种情况的 30 天再入院率和死亡率都很高。包括高风险心肌损伤患者可能对基于价值的计划产生重大影响。
