Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

Abstract

Heart disease continues to be the leading cause of death in the United States, with approximately 805 000 cumulative deaths from myocardial infarctions (MI) from 2005 to 2014. Gender and racial/ethnic disparities in MI diagnoses are becoming more evident in quality review audits. Although recent changes in diagnostic codes provided an improved framework, clinically distinguishing types of MI remains a challenge. MI misdiagnoses and health disparities contribute to adverse outcomes in cardiac medicine. We conducted a literature review of relevant biomedical sources related to the classification of MI and disparities in cardiovascular care and outcomes. From the studies analyzed, African Americans and women have higher rates of mortality from MI, are more probably to be younger and present with other comorbidities and are less probably to receive novel therapies with respect to type of MI. As highsensitivity troponin assays are adopted in the United States, implementation should account for how race and sex differences have been demonstrated in the reference range and diagnostic threshold of the newer assays. More research is needed to assess how the complexity of health disparities contributes to adverse cardiovascular outcomes. Creating dedicated medical quality teams (physicians, nurses, clinical documentation improvement specialists, and medical coders) and incorporating a plan-docheck-adjust quality improvement model are strategies that could potentially help better define and diagnose MI, reduce financial burdens due to MI misdiagnoses, reduce cardiovascular-related health disparities, and ultimately improve and save lives. K E Y W O R D S cardiac, diagnostic codes, international statistical classification of diseases ICD 10, myocardial injury, myocardial infarction < ischemic heart disease, plan-do-check-adjust, quality improvement, troponin

Reproducing extracellular matrix adverse remodelling of non-ST myocardial infarction in a large animal model

“…3b). This data further supports the required criteria to define the current model as representative of an NSTEMI 31 .…”

“…The 4th Universal definition of MI requires a rise and fall of cTn and one other criterion from the following: symptoms of acute ischaemia, new ischaemic ECG Changes, new Qwaves, loss of viable myocardium or a new wall motion abnormality in a pattern consistent with ischaemic etiology via imaging 31,49 . In the current model we demonstrated that it is possible to induce infarcts that fulfil all the criteria that define an NSTEMI Type 1 infarct by this multiple suture procedure.…”

Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

“…As mentioned earlier, studies have shown that patients of lower SES are less likely to undergo MIS [6][7][8][9]. Patients of low SES have been found to be less willing to undergo minimally invasive procedures and are less likely to receive novel therapies in the setting of MI and minimally invasive revascularization procedures [18,19].…”

Clinical Characteristics, Outcomes, and Epidemiological Trends of Patients Admitted With Type 2 Myocardial Infarction

“…Previous literature looking at racial disparities in the management of acute MI has shown mixed data regarding revascularization rates for African Americans compared with other racial cohorts, although a recent nationwide study by Alkhouli et al 20 demonstrated a proportional increase in African Americans undergoing revascularization over the last several decades. [21][22][23][24] When presentation is stratified by STEMI versus NSTEMI, studies have shown decreased revascularization rates and longer median times to revascularization in African Americans presenting with NSTEMI. 21,24 Although there are likely many reasons for these decreased revascularization rates in African Americans, such as an increased prevalence of cardiometabolic comorbidities in this group, it is important to note that the previously mentioned studies either did not differentiate Figure . 3.…”