Discordance between ICD-Coded Myocardial Infarction and Diagnosis according to the Universal Definition of Myocardial Infarction.

Autor:	Díaz-Garzón J; Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Sandoval Y; Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN.; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN., Smith SW; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Love S; Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Schulz K; Minneapolis Medical Research Foundation, Minneapolis, MN., Thordsen SE; Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN.; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN., Johnson BK; Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN.; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN., Driver B; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Jacoby K; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Carlson MD; Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN.; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN., Dodd KW; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Moore J; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Scott NL; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN.; Department of Medicine, Hennepin County Medical Center, Minneapolis, MN., Bruen CA; Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN., Hatch R; Minneapolis Medical Research Foundation, Minneapolis, MN., Apple FS; Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN; apple004@umn.edu.; Minneapolis Medical Research Foundation, Minneapolis, MN.
Jazyk:	angličtina
Zdroj:	Clinical chemistry [Clin Chem] 2017 Jan; Vol. 63 (1), pp. 415-419. Date of Electronic Publication: 2016 Nov 03.
DOI:	10.1373/clinchem.2016.263764
Abstrakt:	Background: International Classification of Diseases (ICD) coding is the standard diagnostic tool for healthcare management. At present, type 2 myocardial infarction (T2MI) classification by the Universal Definition of Myocardial Infarction (MI) remains ignored in the ICD system. We determined the concordance for the diagnosis of MI using ICD-9 coding vs the Universal Definition. Methods: Cardiac troponin I (cTnI) was measured by both contemporary (cTnI) and high-sensitivity (hs-cTnI) assays in 1927 consecutive emergency department (ED) patients [Use of TROPonin In Acute coronary syndromes (UTROPIA) cohort] who had cTnI ordered on clinical indication. All patients were adjudicated using both contemporary and hs-cTnI assays. The Kappa index and McNemar test were used to assess concordance between ICD-9 code 410 and type 1 MI (T1MI) and type 2 MI (T2MI). Results: Among the 249 adjudicated MIs using the contemporary cTnI, only 69 (28%) were ICD-coded MIs. Of 180 patients not ICD coded as MI, 34 (19%) were T1MI and 146 (81%) were T2MI. For the ICD-coded MIs, 79% were T1MI and 21% were T2MI. A fair Kappa index, 0.386, and a McNemar difference of 0.0892 (P < 0.001) were found. Among the 207 adjudicated MIs using the hs-cTnI assay, 67 (32%) were ICD coded as MI. Of the 140 patients not ICD coded as MI, 27 (19%) were T1MI and 113 (81%) were T2MI. For the ICD-coded MIs, 85% were T1MI and 15% T2MI. A moderate Kappa index, 0.439, and a McNemar difference of 0.0674 (P < 0.001) were found. Conclusions: ICD-9-coded MIs captured only a small proportion of adjudicated MIs, primarily from not coding T2MI. Our findings emphasize the need for an ICD code for T2MI. (© 2016 American Association for Clinical Chemistry.)
Databáze:	MEDLINE
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