British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden.
JAMA Netw Open. 2024 Apr 1;7(4):e245853. doi: 10.1001/jamanetworkopen.2024.5853.
Whether the diagnostic classifications proposed by the universal definition of myocardial infarction (MI) to identify type 1 MI due to atherothrombosis and type 2 MI due to myocardial oxygen supply-demand imbalance have been applied consistently in clinical practice is unknown.
To evaluate the application of the universal definition of MI in consecutive patients with possible MI across 2 health care systems.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 2 prospective cohorts enrolling consecutive patients with possible MI in Scotland (2013-2016) and Sweden (2011-2014) to assess accuracy of clinical diagnosis of MI recorded in hospital records for patients with an adjudicated diagnosis of type 1 or type 2 MI. Data were analyzed from August 2022 to February 2023.
The main outcome was the proportion of patients with a clinical diagnosis of MI recorded in the hospital records who had type 1 or type 2 MI, adjudicated by an independent panel according to the universal definition. Characteristics and risk of subsequent MI or cardiovascular death at 1 year were compared.
A total of 50 356 patients were assessed. The cohort from Scotland included 28 783 (15 562 men [54%]; mean [SD] age, 60 [17] years), and the cohort from Sweden included 21 573 (11 110 men [51%]; mean [SD] age, 56 [17] years) patients. In Scotland, a clinical diagnosis of MI was recorded in 2506 of 3187 patients with an adjudicated diagnosis of type 1 MI (79%) and 122 of 716 patients with an adjudicated diagnosis of type 2 MI (17%). Similar findings were observed in Sweden, with 970 of 1111 patients with adjudicated diagnosis of type 1 MI (87%) and 57 of 251 patients with adjudicated diagnosis of type 2 MI (23%) receiving a clinical diagnosis of MI. Patients with an adjudicated diagnosis of type 1 MI without a clinical diagnosis were more likely to be women (eg, 336 women [49%] vs 909 women [36%] in Scotland; P < .001) and older (mean [SD] age, 71 [14] v 67 [14] years in Scotland, P < .001) and, when adjusting for competing risk from noncardiovascular death, were at similar or increased risk of subsequent MI or cardiovascular death compared with patients with a clinical diagnosis of MI (eg, 29% vs 18% in Scotland; P < .001).
In this cohort study, the universal definition of MI was not consistently applied in clinical practice, with a minority of patients with type 2 MI identified, and type 1 MI underrecognized in women and older persons, suggesting uncertainty remains regarding the diagnostic criteria or value of the classification.
用于识别因动脉粥样硬化导致的 1 型心肌梗死（MI）和因心肌氧供需失衡导致的 2 型 MI 的通用 MI 定义提出的诊断分类是否在临床实践中得到一致应用尚不清楚。
评估通用 MI 定义在 2 个医疗保健系统中连续出现可能 MI 的患者中的应用。
设计、设置和参与者：这项队列研究使用了来自 2 个前瞻性队列的数据，这些队列在苏格兰（2013-2016 年）和瑞典（2011-2014 年）连续招募可能患有 MI 的患者，以评估在有明确 1 型或 2 型 MI 诊断的患者的住院记录中记录的 MI 临床诊断的准确性。数据分析于 2022 年 8 月至 2023 年 2 月进行。
主要结局是根据通用定义由独立小组判定为 1 型或 2 型 MI 的患者在住院记录中记录的 MI 临床诊断比例。比较了特征和 1 年时随后发生 MI 或心血管死亡的风险。
共评估了 50356 名患者。来自苏格兰的队列包括 28783 名（15562 名男性[54%]；平均[标准差]年龄，60[17]岁），来自瑞典的队列包括 21573 名（11110 名男性[51%]；平均[标准差]年龄，56[17]岁）患者。在苏格兰，3187 名经明确诊断为 1 型 MI 的患者中有 2506 名（79%）和 716 名经明确诊断为 2 型 MI 的患者中有 122 名（17%）记录了 MI 临床诊断。在瑞典也观察到类似的发现，1111 名经明确诊断为 1 型 MI 的患者中有 970 名（87%）和 251 名经明确诊断为 2 型 MI 的患者中有 57 名（23%）记录了 MI 临床诊断。没有 MI 临床诊断的 1 型 MI 患者更可能是女性（例如，在苏格兰，336 名女性[49%]与 909 名女性[36%]；P<0.001）和年龄更大（平均[标准差]年龄，71[14]比苏格兰的 67[14]岁，P<0.001），并且在校正非心血管死亡的竞争风险后，与有 MI 临床诊断的患者相比，发生后续 MI 或心血管死亡的风险相似或更高（例如，在苏格兰，29%比 18%；P<0.001）。
在这项队列研究中，通用 MI 定义在临床实践中并未得到一致应用，只有少数 2 型 MI 患者得到识别，女性和老年人的 1 型 MI 识别不足，这表明人们对诊断标准或分类的价值仍存在不确定性。
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