Discordance between ICD-coded myocardial infarction and diagnosis according to the Universal Definition of Myocardial Infarction

Jorge Díaz-Garzón, Yader Sandoval, Stephen W. Smith, Sara Love, Karen Schulz, Sarah E. Thordsen, Benjamin K. Johnson, Brian Driver, Katherine Jacoby, Michelle D. Carlson, Kenneth W. Dodd, Johanna Moore, Nathaniel L. Scott, Charles A. Bruen, Ryan Hatch, Fred S. Apple

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

BACKGROUND: International Classification of Diseases (ICD) coding is the standard diagnostic tool for healthcare management. At present, type 2 myocardial infarction (T2MI) classification by the Universal Definition of Myocardial Infarction (MI) remains ignored in the ICD system. We determined the concordance for the diagnosis of MI using ICD-9 coding vs the Universal Definition. METHODS: Cardiac troponin I (cTnI) was measured by both contemporary (cTnI) and high-sensitivity (hscTnI) assays in 1927 consecutive emergency department (ED) patients [Use of TROPonin In Acute coronary syndromes (UTROPIA) cohort] who had cTnI ordered on clinical indication. All patients were adjudicated using both contemporary and hs-cTnI assays. The Kappa index and McNemar test were used to assess concordance between ICD-9 code 410 and type 1 MI (T1MI) and type 2 MI (T2MI). RESULTS: Among the 249 adjudicated MIs using the contemporary cTnI, only 69 (28%) were ICD-coded MIs. Of 180 patients not ICD coded as MI, 34 (19%) were T1MI and 146 (81%) were T2MI. For the ICD-coded MIs, 79% were T1MI and 21% were T2MI. A fair Kappa index, 0.386, and a McNemar difference of 0.0892 (P < 0.001) were found. Among the 207 adjudicated MIs using the hs-cTnI assay, 67 (32%) were ICD coded as MI. Of the 140 patients not ICD coded as MI, 27 (19%) were T1MI and 113 (81%) were T2MI. For the ICD-coded MIs, 85% were T1MI and 15% T2MI. A moderate Kappa index, 0.439, and a McNemar difference of 0.0674 (P < 0.001) were found. CONCLUSIONS: ICD-9-coded MIs captured only a small proportion of adjudicated MIs, primarily from not coding T2MI. Our findings emphasize the need for an ICD code for T2MI.

Original languageEnglish (US)
Pages (from-to)415-419
Number of pages5
JournalClinical chemistry
Volume63
Issue number1
DOIs
StatePublished - Jan 2017

Bibliographical note

Funding Information:
F.S. Apple, research through Minneapolis Medical Research Foundation (MMRF), not salaried: Abbott Diagnostics, Roche Diagnostics, Siemens Healthcare, Alere, Trinity, Nanomix, Becton Dickinson.

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