PMID- 36795598
OWN - NLM
STAT- MEDLINE
DCOM- 20240115
LR  - 20240301
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Print)
IS  - 0003-2999 (Linking)
VI  - 138
IP  - 2
DP  - 2024 Feb 1
TI  - Trends and In-Hospital Mortality for Perioperative Myocardial Infarction After 
      the Introduction of a Diagnostic Code for Type 2 Myocardial Infarction in the 
      United States Between 2016 and 2018.
PG  - 420-429
LID - 10.1213/ANE.0000000000006404 [doi]
AB  - 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.
CI  - Copyright (c) 2023 International Anesthesia Research Society.
FAU - Rubin, Daniel S
AU  - Rubin DS
AD  - From the Department of Anesthesia and Critical Care, The University of Chicago 
      Medical Center, Chicago, Illinois.
FAU - Lin, Antonia Z
AU  - Lin AZ
AD  - Department of Anesthesiology, Rush Medical Center, Chicago, Illinois.
FAU - Ward, R Parker
AU  - Ward RP
AD  - Department of Medicine, Section of Cardiology, University of Chicago, Chicago, 
      Illinois.
FAU - Nagele, Peter
AU  - Nagele P
AD  - Department of Anesthesia and Critical Care, University of Chicago, Chicago, 
      Illinois.
LA  - eng
GR  - R03 AG078957/AG/NIA NIH HHS/United States
PT  - Journal Article
DEP - 20230216
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
SB  - IM
MH  - Humans
MH  - Female
MH  - United States/epidemiology
MH  - Middle Aged
MH  - Male
MH  - *Non-ST Elevated Myocardial Infarction/diagnosis/epidemiology
MH  - *ST Elevation Myocardial Infarction/diagnosis/epidemiology
MH  - Hospital Mortality
MH  - Longitudinal Studies
MH  - *Myocardial Infarction/diagnosis/epidemiology/etiology
MH  - Risk Factors
PMC - PMC10427730
MID - NIHMS1862708
COIS- Conflicts of Interest: See Disclosures at the end of the article.
EDAT- 2023/02/17 06:00
MHDA- 2024/01/15 12:42
PMCR- 2025/02/01
CRDT- 2023/02/16 13:02
PHST- 2025/02/01 00:00 [pmc-release]
PHST- 2024/01/15 12:42 [medline]
PHST- 2023/02/17 06:00 [pubmed]
PHST- 2023/02/16 13:02 [entrez]
AID - 00000539-202402000-00019 [pii]
AID - 10.1213/ANE.0000000000006404 [doi]
PST - ppublish
SO  - Anesth Analg. 2024 Feb 1;138(2):420-429. doi: 10.1213/ANE.0000000000006404. Epub 
      2023 Feb 16.