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Deprecated: Implicit conversion from float 267.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Am+Heart+Assoc 2018 ; 7 (7): ä Nephropedia Template TP
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Impact of Type 2 Myocardial Infarction (MI) on Hospital?Level MI Outcomes: Implications for Quality and Public Reporting #MMPMID29581221
J Am Heart Assoc 2018[Apr]; 7 (7): ä PMID29581221show ga
Background: The 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 Results: We 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). Conclusions: NSTEMI 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.