Hawatmeh Amer, Thawabi Mohammad, Aggarwal Rashmi, Abirami Chandra, Vavilin Ilan, Wasty Najam, Visveswaran Gautam, Cohen Marc
Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States.
Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States.
Cardiovasc Revasc Med. 2020 Feb;21(2):176-179. doi: 10.1016/j.carrev.2019.04.009. Epub 2019 Apr 12.
Patients with type 2 myocardial infarction (MI) are often classified under the diagnosis of non-ST-segment-elevation MI (NSTEMI) despite the significant differences in clinical characteristics, management, and outcomes between type 2 MI and type 1 NSTEMI. This may have significant implications that can lead to inaccurate assessment of quality measures by MI quality review programs.
A single-center retrospective study of 1224 patients discharged with the diagnosis of type 1 NSTEMI between January 2015 and September 2017. Based on the third universal definition of MI, we stratified patients into type 2 MI or type 1 NSTEMI. Patient's characteristics, comorbidities, medications prescribed during hospitalization and at discharge, readmissions within 30 days after discharge, and diagnostic and therapeutic interventions data was collected. The primary goal of this study was to identify how often type 2 MI patients were misclassified as type 1 NSTEMI, we also assessed the differences in treatment and outcomes between type 2 MI and type 1 NSTEMI.
1224 patients assigned the ICD-9 and ICD-10 codes of type 1 NSTEMI at discharge were evaluated for study inclusion. After application of the inclusion criteria, 945 patients were included in the final analysis. Of these 945 patients, 281 (29.7%) patients were classified as type 2 MI and 664 (70.3%) patients were classified as type 1 NSTEMI. Patients with type 2 MI were older, more likely to have systolic heart failure, had lower peak troponin levels, were less likely to receive aspirin, P2Y12 inhibitors and statin at discharge, and had longer length of stay. Compared with type 1 NSTEMI patients, those with type 2 MI had higher all cause 30-day mortality (13.5% versus 2.9%, P < 0.0001) (RR: 4.65; 95% CI, 2.85-9.65). After adjusting for patient demographics, comorbidities, and medications, patients with type 2 MI were still more likely to die within 30 days after discharge (RR: 2.89; 95% CI, 1.58-7.46). In addition, patients with type 2 MI were more likely to be readmitted within 30 days after discharge than patients with type 1 NSTEMI (17.7% versus 13.9%, P < 0.01) (RR: 1.27; 95% CI, 1.08-2.5).
Close to one third of patients given the diagnosis of type 1 NSTEMI at discharge at our institution were type 2 MI patients. Patients with type 2 MI are managed differently from type 1 NSTEMI patients and have higher 30-day mortality and readmission rate. Misclassification of type 2 MI as type 1 NSTEMI can have a significant impact on hospitals MI clinical performance and quality measures.
尽管2型心肌梗死（MI）与1型非ST段抬高型心肌梗死（NSTEMI）在临床特征、治疗及预后方面存在显著差异，但2型MI患者常被归类于NSTEMI诊断之下。这可能产生重大影响，导致MI质量评估项目对质量指标的评估不准确。
对2015年1月至2017年9月间出院诊断为1型NSTEMI的1224例患者进行单中心回顾性研究。基于MI的第三次通用定义，我们将患者分为2型MI或1型NSTEMI。收集患者的特征、合并症、住院期间及出院时所开药物、出院后30天内再入院情况以及诊断和治疗干预数据。本研究的主要目的是确定2型MI患者被误诊为1型NSTEMI的频率，我们还评估了2型MI与1型NSTEMI在治疗和预后方面的差异。
对出院时被分配1型NSTEMI的ICD - 9和ICD - 10编码的1224例患者进行纳入研究评估。应用纳入标准后，945例患者纳入最终分析。在这945例患者中，281例（29.7%）患者被归类为2型MI，664例（70.3%）患者被归类为1型NSTEMI。2型MI患者年龄更大，更易发生收缩性心力衰竭，肌钙蛋白峰值水平较低，出院时接受阿司匹林、P2Y12抑制剂和他汀类药物治疗的可能性较小，住院时间更长。与1型NSTEMI患者相比，2型MI患者全因30天死亡率更高（13.5%对2.9%，P < 0.0001）（风险比：4.65；95%置信区间，2.85 - 9.65）。在对患者人口统计学、合并症和药物进行调整后，2型MI患者出院后30天内死亡的可能性仍然更高（风险比：2.89；95%置信区间，1.58 - 7.46）。此外，2型MI患者出院后30天内再入院的可能性高于1型NSTEMI患者（17.7%对13.9%，P < 0.01）（风险比：1.27；95%置信区间，1.08 - 2.5）。
在我们机构出院时被诊断为1型NSTEMI的患者中，近三分之一是2型MI患者。2型MI患者的治疗方式与1型NSTEMI患者不同，30天死亡率和再入院率更高。将2型MI误诊为1型NSTEMI可能对医院MI临床绩效和质量指标产生重大影响。
