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Interphysician agreement on subclassification of myocardial infarction
OBJECTIVE: The universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how oft...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204971/ https://www.ncbi.nlm.nih.gov/pubmed/29453330 http://dx.doi.org/10.1136/heartjnl-2017-312409 |
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author | Gard, Anton Lindahl, Bertil Batra, Gorav Hadziosmanovic, Nermin Hjort, Marcus Szummer, Karolina Elisabeth Baron, Tomasz |
author_facet | Gard, Anton Lindahl, Bertil Batra, Gorav Hadziosmanovic, Nermin Hjort, Marcus Szummer, Karolina Elisabeth Baron, Tomasz |
author_sort | Gard, Anton |
collection | PubMed |
description | OBJECTIVE: The universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement. METHODS: A total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included. All patients were retrospectively reclassified into different MI or myocardial injury subtypes by two independent specially trained physicians, strictly adhering to the third universal definition of MI. RESULTS: Overall, there was a moderate interobserver agreement with a kappa coefficient (κ) of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (κ: 0.61), compared with moderate agreement when distinguishing type 2 MI (κ: 0.54). In multivariate logistic regression analyses, ST elevation MI (P<0.001), performed coronary angiography (P<0.001) and larger changes in troponin levels (P=0.023) independently made the physicians agree significantly more often, while they disagreed more often with symptoms of dyspnoea (P<0.001), higher systolic blood pressure (P=0.001) and higher C reactive protein levels on admission (P=0.016). CONCLUSION: Distinguishing MI types is challenging also for trained adjudicators. Although strictly adhering to the third universal definition of MI, differentiation between type 1 MI, type 2 MI and myocardial injury only gave a moderate rate of interobserver agreement. More precise and clinically applicable criteria for the current classification, particularly for type 2 MI diagnosis, are urgently needed. |
format | Online Article Text |
id | pubmed-6204971 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-62049712018-11-08 Interphysician agreement on subclassification of myocardial infarction Gard, Anton Lindahl, Bertil Batra, Gorav Hadziosmanovic, Nermin Hjort, Marcus Szummer, Karolina Elisabeth Baron, Tomasz Heart Coronary Artery Disease OBJECTIVE: The universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement. METHODS: A total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included. All patients were retrospectively reclassified into different MI or myocardial injury subtypes by two independent specially trained physicians, strictly adhering to the third universal definition of MI. RESULTS: Overall, there was a moderate interobserver agreement with a kappa coefficient (κ) of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (κ: 0.61), compared with moderate agreement when distinguishing type 2 MI (κ: 0.54). In multivariate logistic regression analyses, ST elevation MI (P<0.001), performed coronary angiography (P<0.001) and larger changes in troponin levels (P=0.023) independently made the physicians agree significantly more often, while they disagreed more often with symptoms of dyspnoea (P<0.001), higher systolic blood pressure (P=0.001) and higher C reactive protein levels on admission (P=0.016). CONCLUSION: Distinguishing MI types is challenging also for trained adjudicators. Although strictly adhering to the third universal definition of MI, differentiation between type 1 MI, type 2 MI and myocardial injury only gave a moderate rate of interobserver agreement. More precise and clinically applicable criteria for the current classification, particularly for type 2 MI diagnosis, are urgently needed. BMJ Publishing Group 2018-08 2018-02-16 /pmc/articles/PMC6204971/ /pubmed/29453330 http://dx.doi.org/10.1136/heartjnl-2017-312409 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Coronary Artery Disease Gard, Anton Lindahl, Bertil Batra, Gorav Hadziosmanovic, Nermin Hjort, Marcus Szummer, Karolina Elisabeth Baron, Tomasz Interphysician agreement on subclassification of myocardial infarction |
title | Interphysician agreement on subclassification of myocardial infarction |
title_full | Interphysician agreement on subclassification of myocardial infarction |
title_fullStr | Interphysician agreement on subclassification of myocardial infarction |
title_full_unstemmed | Interphysician agreement on subclassification of myocardial infarction |
title_short | Interphysician agreement on subclassification of myocardial infarction |
title_sort | interphysician agreement on subclassification of myocardial infarction |
topic | Coronary Artery Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204971/ https://www.ncbi.nlm.nih.gov/pubmed/29453330 http://dx.doi.org/10.1136/heartjnl-2017-312409 |
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