Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes: Implications for quality and public reporting

Sameer Arora, Paula D. Strassle, Arman Qamar, Evan N. Wheeler, Alexandra L. Levine, Jacob A. Misenheimer, Matthew A. Cavender, George A. Stouffer, Prashant Kaul

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Background--The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment- elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. Methods and Results--We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4% versus 4.7%, P < 0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%, P < 0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95% confidence interval, 0.12-2.06). Conclusions--NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics.

Original languageEnglish (US)
Article numbere008661
JournalJournal of the American Heart Association
Issue number7
StatePublished - Apr 1 2018


  • Coronary artery disease
  • Mortality
  • Myocardial infarction
  • Readmission
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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