Trends and In-Hospital Mortality for Perioperative Myocardial Infarction After the Introduction of a Diagnostic Code
Daniel S Rubin1, Antonia Z Lin2, R Parker Ward3
1From the Department of Anesthesia and Critical Care, The University of Chicago Medical Center, Chicago, Illinois.
Insights
The introduction of a diagnostic code for type 2 myocardial infarction did not increase perioperative myocardial infarction frequency. Type 2 myocardial infarction diagnosis was not linked to higher in-hospital mortality, but further research on interventions is needed.
Area of Science:
- Cardiology
- Healthcare Analytics
- Surgical Outcomes
Background:
- Perioperative myocardial infarction (MI) frequency is declining, but prior studies focused only on Type 1 MI.
- This study examines the impact of the Type 2 MI diagnostic code on overall MI frequency and in-hospital mortality.
- Utilizing the International Classification of Diseases 10th revision (ICD-10-CM) code for Type 2 MI provides a more comprehensive understanding.
Purpose of the Study:
- To evaluate the overall frequency of perioperative myocardial infarction after the introduction of the ICD-10-CM code for Type 2 MI.
- To determine the independent association between Type 2 MI and in-hospital mortality.
- To analyze the trends in MI frequency and types following the diagnostic code implementation.
Main Methods:
- A longitudinal cohort study using the National Inpatient Sample (NIS) from 2016-2018.
- Included hospital discharges with major surgical procedures (intrathoracic, intraabdominal, suprainguinal vascular surgery).
- Used segmented and multivariable logistic regression to analyze MI frequency trends and mortality associations.
Main Results:
- Overall MI incidence was 0.76% (1,801,239 discharges).
- The Type 2 MI code introduction did not significantly alter the trend in perioperative MI frequency.
- Type 2 MI was not associated with increased in-hospital mortality (OR, 1.11; 95% CI, 0.81-1.53), unlike STEMI and NSTEMI.
Conclusions:
- The introduction of the Type 2 MI diagnostic code did not lead to an increase in perioperative MI frequency.
- Type 2 MI diagnosis showed no association with increased in-patient mortality in this cohort.
- Further research is required to identify optimal interventions for Type 2 MI patients.
Background:
The frequency of perioperative myocardial infarction has been declining; however, previous studies have only described type 1 myocardial infarctions. Here, we evaluate the overall frequency of myocardial infarction with the addition of an International Classification of Diseases 10th revision (ICD-10-CM) code for type 2 myocardial infarction and the independent association with in-hospital mortality.
Methods:
A longitudinal cohort study spanning the introduction of the ICD-10-CM diagnostic code for type 2 myocardial infarction using the National Inpatient Sample (NIS) from 2016 to 2018. Hospital discharges that included a primary surgical procedure code for intrathoracic, intraabdominal, or suprainguinal vascular surgery were included. Type 1 and type 2 myocardial infarctions were identified using ICD-10-CM codes. We used segmented logistic regression to estimate change in frequency of myocardial infarctions and multivariable logistic regression to determine the association with in-hospital mortality.
Results:
A total of 360,264 unweighted discharges were included, representing 1,801,239 weighted discharges, with median age 59 and 56% female. The overall incidence of myocardial infarction was 0.76% (13,605/1,801,239). Before the introduction of type 2 myocardial infarction code, there was a small baseline decrease in the monthly frequency of perioperative myocardial infarctions (odds ratio [OR], 0.992; 95% confidence interval [CI], 0.984-1.000; P = .042), but no change in the trend after the introduction of the diagnostic code (OR, 0.998; 95% CI, 0.991-1.005; P = .50). In 2018, where there was an entire year where type 2 myocardial infarction was officially a diagnosis, the distribution of myocardial infarction type 1 was 8.8% (405/4580) ST elevation myocardial infarction (STEMI), 45.6% (2090/4580) non-ST elevation myocardial infarction (NSTEMI), and 45.5% (2085/4580) type 2 myocardial infarction. STEMI and NSTEMI were associated with increased in-hospital mortality (OR, 8.96; 95% CI, 6.20-12.96; P < .001 and OR, 1.59; 95% CI, 1.34-1.89; P < .001). A diagnosis of type 2 myocardial infarction was not associated with increased odds of in-hospital mortality (OR, 1.11; 95% CI, 0.81-1.53; P = .50) when accounting for surgical procedure, medical comorbidities, patient demographics, and hospital characteristics.
Conclusions:
The frequency of perioperative myocardial infarctions did not increase after the introduction of a new diagnostic code for type 2 myocardial infarctions. A diagnosis of type 2 myocardial infarction was not associated with increased in-patient mortality; however, few patients received invasive management that may have confirmed the diagnosis. Further research is needed to identify what type of intervention, if any, may improve outcomes in this patient population.
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