Impact of Type 2 Myocardial Infarction (MI) on Hospital‐Level MI Outcomes: Implications for Quality and Public Reporting

Autor: George A. Stouffer, Prashant Kaul, Alexandra L. Levine, Jacob A. Misenheimer, Matthew A. Cavender, Sameer Arora, Arman Qamar, Evan N. Wheeler, Paula D. Strassle
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Time Factors
030204 cardiovascular system & hematology
Coronary artery disease
0302 clinical medicine
Risk Factors
Cause of Death
Risk of mortality
Coronary Heart Disease
030212 general & internal medicine
Myocardial infarction
Hospital Mortality
Non-ST Elevated Myocardial Infarction
Original Research
Aged
80 and over
Quality and Outcomes
biology
troponin
Middle Aged
3. Good health
Hospitalization
myocardial infarction
Outcome and Process Assessment
Health Care
Treatment Outcome
Female
Mortality/Survival
Cardiology and Cardiovascular Medicine
coronary artery disease
medicine.medical_specialty
Patient Readmission
Risk Assessment
03 medical and health sciences
Public reporting
Internal medicine
medicine
Humans
Aged
Quality Indicators
Health Care
Retrospective Studies
business.industry
readmission
Hospital level
medicine.disease
Troponin
mortality
Etiology
biology.protein
business
Acute Coronary Syndromes
Kidney disease
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: 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 P 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.
Databáze: OpenAIRE
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