Martin Elliot A, Har Bryan, Walker Robin L, Southern Danielle A, Quan Hude, Eastwood Cathy A
Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada.
Provincial Research Data Services, Alberta Health Services, Calgary, AB T2N 4Z6, Canada.
J Clin Med. 2024 Dec 19;13(24):7773. doi: 10.3390/jcm13247773.
: The fourth universal definition of myocardial infarction (MI) introduced the differentiation of acute myocardial injury from MI. In this study, we developed a computational phenotype for distinct identification of acute myocardial injury and MI within electronic medical records (EMRs). : Two cohorts were used from a Calgary-wide EMR system: a chart review of 3042 randomly selected inpatients from Dec 2014 to Jun 2015; and 11,685 episodes of care that included cardiac catheterization from Jan 2013 to Apr 2017. Electrocardiogram (ECG) reports were processed using natural language processing and combined with high-sensitivity troponin lab results to classify patients as having an acute myocardial injury, MI, or neither. : For patients with an MI diagnosis, only 64.0% (65.7%) in the catheterized cohorts (chart review cohort) had two troponin measurements within 6 h of each other. For patients with two troponin measurements within 6 h; of those with an MI diagnosis, our phenotype classified 25.2% (31.3%) with an acute myocardial injury and 62.2% (55.2%) with an MI in the catheterized cohort (chart review cohort); and of those without an MI diagnosis, our phenotype classified 12.9% (12.4%) with an acute myocardial injury and 10.0% (13.1%) with an MI in the catheterized cohort (chart review cohort). : Patients with two troponin measurements within 6 h, identified by our phenotype as having either an acute myocardial injury or MI, will at least meet the diagnostic criteria for an acute myocardial injury (barring lab errors) and indicate many previously uncaptured cases. Myocardial infarctions are harder to be certain of because ECG report findings might be superseded by evidence not included in our phenotype, or due to errors with the natural language processing.
心肌梗死（MI）的第四个通用定义引入了急性心肌损伤与MI的区分。在本研究中，我们开发了一种计算表型，用于在电子病历（EMR）中明确识别急性心肌损伤和MI。
使用卡尔加里全市范围的EMR系统中的两个队列：对2014年12月至2015年6月随机选取的3042名住院患者进行病历审查；以及2013年1月至2017年4月包括心脏导管插入术的11685次护理事件。使用自然语言处理对心电图（ECG）报告进行处理，并结合高敏肌钙蛋白实验室结果，将患者分类为患有急性心肌损伤、MI或两者皆无。
对于诊断为MI的患者，在导管插入术队列（病历审查队列）中，只有64.0%（65.7%）的患者在彼此6小时内进行了两次肌钙蛋白测量。对于在6小时内进行了两次肌钙蛋白测量的患者；在诊断为MI的患者中，我们的表型在导管插入术队列（病历审查队列）中，将25.2%（31.3%）分类为患有急性心肌损伤，62.2%（55.2%）分类为患有MI；在未诊断为MI的患者中，我们的表型在导管插入术队列（病历审查队列）中，将12.9%（12.4%）分类为患有急性心肌损伤，10.0%（13.1%）分类为患有MI。
我们的表型识别出在6小时内进行了两次肌钙蛋白测量且患有急性心肌损伤或MI的患者，至少将符合急性心肌损伤的诊断标准（排除实验室误差），并表明存在许多先前未被发现的病例。由于ECG报告结果可能被我们的表型中未包括的证据所取代，或者由于自然语言处理错误，心肌梗死更难确定。
