Validity of the International Classification of Diseases, Tenth Revision codes in diagnosing myocardial infarction
Connor Suscha1, Elaine Luterstein2, Nhi Tong3
1Heart and Vascular Institute, Mass General Brigham, Boston, MA.
Background:
International Classification of Diseases, Tenth Revision (ICD-10) codes are commonly used for identifying myocardial infarction (MI) in clinical research and increasingly used to capture events in clinical trials; however, their accuracy for distinguishing MI subtypes is uncertain.
Methods:
In this secondary analysis of a single-center prospective cohort study, consecutive individuals who underwent highsensitivity cardiac troponin testing between October 2023 and February 2025 were adjudicated by physicians as either an MI subtype, myocardial injury, or non-elevated troponin. Clinician adjudicated diagnoses were compared to ICD-10 codes attributable to type 1 MI, type 2 MI, and type 3-5 MI.
Results:
In a study of 24,524 individuals undergoing troponin testing, type 1 MI ICD-10 codes showed moderate sensitivity (53%) but high specificity (99%), whereas the ICD-10 codes for type 2 MI and types 3-5 MI demonstrated extremely low sensitivities (3% and 0%, respectively) despite high sepificitiy (99%).
Conclusions:
These data suggest the ICD-10 codes for each individual MI subtype have such low sensitivity that they may not reliably and accurately identify these MI subtypes in clinical research or in quality metrics and value-based programs.
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