Reconciling Systems for Acute Myocardial Infarction Definition and Coding Classification

[摘要] According to the Third Universal Definition of Myocardial Infarction (3rd UDMI),2 a consensus document from the European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation, the term “acute myocardial infarction” can be used when there is “evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischemia” (1). Although the 3rd UDMI document specified 5 categories, or “types,” of acute myocardial infarction, the categories most relevant in general practice are “Type 1” (acute myocardial infarction resulting from coronary artery plaque rupture with thrombosis) and “Type 2” (acute myocardial infarction resulting from a mismatch of myocardial oxygen supply and demand). For both Type 1 and Type 2 acute myocardial infarction, there must be a characteristic rise and/or fall in levels of biomarkers of myocardial necrosis (cardiac troponin preferred), and at least 1 value must be above the 99th percentile for the assay used. Further, biomarker evidence of acute myocardial infarction must be associated with at least one of the following: symptoms of acute coronary ischemia, new or presumed new ST-segment changes or left bundle branch block acutely on the electrocardiogram, development of new pathologic Q waves on serial electrocardiograms obtained after presentation, new regional wall motion abnormalities or loss of viable myocardium by cardiac imaging studies, or presence of coronary thrombus at angiography or autopsy. For regions of the world that have no resource constraints, including the US, the WHO has adopted the key principles of the UDMI (2). Although the WHO owns and publishes the International Classification of Diseases (ICD) coding system, it has not incorporated specific codes for the system of acute myocardial infarction types identified in the 3rd UDMI.The adoption of the 3rd UDMI in clinical practice has been met with some confusion and uncertainty among clinicians and coders alike particularly …

[学科分类] 过敏症与临床免疫学