1. Application of the Universal Definition of Myocardial Infarction in Clinical Practice in Scotland and Sweden
- Author
-
Taggart, Caelan, Roos, Andreas, Kadesjö, Erik, Anand, Atul, Li, Ziwen, Doudesis, Dimitrios, Lee, Kuan Ken, Bularga, Anda, Wereski, Ryan, Lowry, Matthew T. H., Chapman, Andrew R., Ferry, Amy V., Shah, Anoop S. V., Gard, Anton, Lindahl, Bertil, Edgren, Gustaf, Mills, Nicholas L., Kimenai, Dorien M., Taggart, Caelan, Roos, Andreas, Kadesjö, Erik, Anand, Atul, Li, Ziwen, Doudesis, Dimitrios, Lee, Kuan Ken, Bularga, Anda, Wereski, Ryan, Lowry, Matthew T. H., Chapman, Andrew R., Ferry, Amy V., Shah, Anoop S. V., Gard, Anton, Lindahl, Bertil, Edgren, Gustaf, Mills, Nicholas L., and Kimenai, Dorien M.
- Abstract
Importance: Whether the diagnostic classifications proposed by the universal definition of myocardial infarction (MI) to identify type 1 MI due to atherothrombosis and type 2 MI due to myocardial oxygen supply-demand imbalance have been applied consistently in clinical practice is unknown. Objective: To evaluate the application of the universal definition of MI in consecutive patients with possible MI across 2 health care systems. Design, Setting, and Participants: This cohort study used data from 2 prospective cohorts enrolling consecutive patients with possible MI in Scotland (2013-2016) and Sweden (2011-2014) to assess accuracy of clinical diagnosis of MI recorded in hospital records for patients with an adjudicated diagnosis of type 1 or type 2 MI. Data were analyzed from August 2022 to February 2023. Main Outcomes and Measures: The main outcome was the proportion of patients with a clinical diagnosis of MI recorded in the hospital records who had type 1 or type 2 MI, adjudicated by an independent panel according to the universal definition. Characteristics and risk of subsequent MI or cardiovascular death at 1 year were compared. Results: A total of 50 356 patients were assessed. The cohort from Scotland included 28 783 (15 562 men [54%]; mean [SD] age, 60 [17] years), and the cohort from Sweden included 21 573 (11 110 men [51%]; mean [SD] age, 56 [17] years) patients. In Scotland, a clinical diagnosis of MI was recorded in 2506 of 3187 patients with an adjudicated diagnosis of type 1 MI (79%) and 122 of 716 patients with an adjudicated diagnosis of type 2 MI (17%). Similar findings were observed in Sweden, with 970 of 1111 patients with adjudicated diagnosis of type 1 MI (87%) and 57 of 251 patients with adjudicated diagnosis of type 2 MI (23%) receiving a clinical diagnosis of MI. Patients with an adjudicated diagnosis of type 1 MI without a clinical diagnosis were more likely to be women (eg, 336 women [49%] vs 909 women [36%] in Scotland; P < .001) and o
- Published
- 2024
- Full Text
- View/download PDF