![]() The standard definition was the presence of the following codes in the primary diagnosis field: ICD-10 codes I21.0-3 for STEMI and I21.4x for non-STEMI.Ī patient presenting with an ECG indicative of STEMI can progress to Q-wave MI, a non-Q-wave MI or an aborted MI, whereas those with no ST-elevation on the ECG are considered to have non-STEMI and can progress only to non-Q-wave MI or unstable angina. We used 2 definitions to categorize patients with acute MI as having STEMI or non-STEMI. The classification of acute MI subtype based on clinician chart review was used as the reference standard.ĭefining STEMI and non-STEMI in administrative data 13 If the 2 physicians disagreed on the diagnosis, a third physician (R.C.W.) read the ECG to determine STEMI or non-STEMI. and W.T.) interpreted the 12-lead ECG and reviewed peak myocardial enzymes to determine the clinical diagnosis of non-STEMI versus STEMI. Subsequently, 2 experienced clinicians (S.S. The charts of patients with a diagnosis of acute MI were independently abstracted to obtain an approximately equal sample of patients identified as having STEMI and non-STEMI. 1 and June 30, 2007, from the 3 major hospitals in the Vital Heart Response program. ![]() To validate the standardized chart abstraction process and confirm appropriate patient selection, we obtained the charts of all patients discharged between Apr. This program is a regional reperfusion program focused on delivering expeditious evidence-based care to patients with STEMI. This review is conducted as part of a dedicated quality-assurance program linked to the Vital Heart Response clinical program. The charts of all patients discharged from hospital with a diagnosis of acute MI in Edmonton (population of about 1 million), undergo review by a trained chart abstractor. We also examined the extent to which in-hospital mortality estimates were affected by the use of the alternative definitions.ĭefining STEMI and non-STEMI in chart data The primary objective of our study was to evaluate the agreement between chart review by clinicians and the standard definition (based on ICD-10 Q-wave codes alone) and ECG definition (based on supplementary ECG codes) for classifying STEMI and non-STEMI. 12 It is not known whether these supplementary codes are more accurate than the standard ICD-10 codes in differentiating between the acute MI subtypes. 11 In April 2007, the Canadian version of ICD-10 introduced secondary diagnosis codes for cardiovascular function based on the electrocardiogram (ECG) findings. ![]() ![]() 9, 10 However, the improved ICD-10 codes distinguish between patients with STEMI and those with non-STEMI. Historically, owing primarily to limitations in coding algorithms, studies using administrative data to examine treatment and outcomes of acute MI have grouped STEMI and non-STEMI together. 7, 8 These differences underline the importance of accurately classifying acute myocardial infarction (MI) subtypes when examining patient outcomes. The incidence and clinical characteristics of patients presenting with ST-elevation myocardial infarction (STEMI) and those of patients with non-ST-elevation myocardial infarction (non-STEMI) vary greatly. ![]() Because the World Health Organization permits its member countries to add country-specific diagnosis codes or specify conditions using subcodes in ICD-10, several countries have developed their own ICD-10 versions. 6 As of October 2015, all developed countries, including the US, are using version 10 of the ICD. 1 - 5 In these databases, the diagnoses and procedures are coded with the use of the World Health Organization International Classification of Diseases (ICD). Health care administrative databases, such as those maintained by the Centers for Medicare and Medicaid Services in the United States and by provincial and federal agencies in Canada and other countries, are extremely useful for assessing the population-level burden of disease and examining issues related to access, costs and quality of care. These findings may be relevant for the development of later versions of ICD codes. Interpretation: The standard definition appears equivalent to the definition using supplementary ECG codes to subcategorize patients with acute MI as having STEMI or non-STEMI. ![]()
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