{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:58:12Z","timestamp":1792029492591,"version":"4.4.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2015,11,3]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Current classification schemes for acute myocardial infarction (AMI) may not accommodate the breadth of clinical phenotypes in young women.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>We developed a novel taxonomy among young adults (\u226455 years) with AMI enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. We first classified a subset of patients (n=600) according to the Third Universal Definition of MI using a structured abstraction tool. There was heterogeneity within type 2 AMI, and 54 patients (9%; including 51 of 412 women) were unclassified. Using an inductive approach, we iteratively grouped patients with shared clinical characteristics, with the aims of developing a more inclusive taxonomy that could distinguish unique clinical phenotypes. The final VIRGO taxonomy classified 2802 study participants as follows: class 1, plaque-mediated culprit lesion (82.5% of women; 94.9% of men); class 2, obstructive coronary artery disease with supply-demand mismatch (2a: 1.4% women; 0.9% men) and without supply-demand mismatch (2b: 2.4% women; 1.1% men); class 3, nonobstructive coronary artery disease with supply-demand mismatch (3a: 4.3% women; 0.8% men) and without supply-demand mismatch (3b: 7.0% women; 1.9% men); class 4, other identifiable mechanism (spontaneous dissection, vasospasm, embolism; 1.5% women, 0.2% men); and class 5, undetermined classification (0.8% women, 0.2% men).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Approximately 1 in 8 young women with AMI is unclassified by the Universal Definition of MI. We propose a more inclusive taxonomy that could serve as a framework for understanding biological disease mechanisms, therapeutic efficacy, and prognosis in this population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.115.016502","type":"journal-article","created":{"date-parts":[[2015,9,9]],"date-time":"2015-09-09T02:16:02Z","timestamp":1441764962000},"page":"1710-1718","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) Classification System"],"prefix":"10.1161","volume":"132","author":[{"given":"Erica S.","family":"Spatz","sequence":"first","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie A.","family":"Curry","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick A.","family":"Masoudi","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengfan","family":"Zhou","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Strait","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary P.","family":"Gross","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeptha P.","family":"Curtis","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra J.","family":"Lansky","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Augusto","family":"Soares Barreto-Filho","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianna F.","family":"Lampropulos","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Bueno","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarwat I.","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"D\u2019Onofrio","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basmah","family":"Safdar","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel P.","family":"Dreyer","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Murugiah","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT;..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199907223410401"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.18.2054"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.054"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00107-1"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.10.019"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.011201"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-142-9-200505030-00015"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.3.276"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826e1058"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01770-9"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.928713"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.742775"},{"key":"e_1_3_3_14_2","volume-title":"Qualitative Research and Evaluation Methods","author":"Patton MQ","year":"2002","unstructured":"Patton MQQualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publications; 2002."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2006.00684.x"},{"key":"e_1_3_3_16_2","volume-title":"Structured Implicit Review of the Medical Record: A Method for Measuring the Quality of Inhospital Medical Care and a Summary of Quality Changes Following Implementation of the Medicare Prospective Payment System","author":"Rubenstein LV","year":"1991","unstructured":"Rubenstein LV, Kahn KL, Harrison ER, Sherwood MJ, Rogers WH, Brook RHStructured Implicit Review of the Medical Record: A Method for Measuring the Quality of Inhospital Medical Care and a Summary of Quality Changes Following Implementation of the Medicare Prospective Payment System. Santa Monica, CA: RAND; 1991."},{"key":"e_1_3_3_17_2","volume-title":"In: Creating and Designing the Healthcare Experience: The International Ergonomics Association","author":"Hutchinson A","year":"2008","unstructured":"Hutchinson A, Coster JE, Cooper KL, McIntosh A, Bath P, Walters SJ, Pearson M. Implicit and explicit case note review: two sides of the same coin? In: Creating and Designing the Healthcare Experience: The International Ergonomics Association. Strasbourg; 2008."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199908000-00009"},{"key":"e_1_3_3_19_2","first-page":"2","volume-title":"Using Clinical Practice Guidelines to Evaluate Quality of Care","author":"Agency for Health Care Policy and Research","year":"1995","unstructured":"Agency for Health Care Policy and Research. Using Clinical Practice Guidelines to Evaluate Quality of Care. U.S. Department of Health and Human Services. Public Health Service; 1995;2."},{"key":"e_1_3_3_20_2","volume-title":"Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory","author":"Strauss AL","year":"1998","unstructured":"Strauss AL, Corbin JBasics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications; 1998."},{"key":"e_1_3_3_21_2","volume-title":"The Discovery of Grounded Research: Strategies for Qualitative Research","author":"Glaser BG","year":"1967","unstructured":"Glaser BG, Strauss ALThe Discovery of Grounded Research: Strategies for Qualitative Research. New York, NY: Aldine De Gruyter; 1967."},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182742c84"},{"key":"e_1_3_3_23_2","unstructured":"American Heart Association: Quality of Care and Outcomes Research Scientific Sessions. Poster Presentation. June 2-4 2014. Baltimore MD."},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.01.022"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.11.3.233"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-118-7-199304010-00010"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.4.415"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.026542"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7873"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.541"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.055855"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.01.054"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.109.860981"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.01.040"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.115.016502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:54:57Z","timestamp":1715583297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.115.016502"}},"subtitle":["A Taxonomy for Young Women With Acute Myocardial Infarction"],"short-title":[],"issued":{"date-parts":[[2015,11,3]]},"references-count":33,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2015,11,3]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.115.016502"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.115.016502","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,3]]},"assertion":[{"value":"2015-03-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-08-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-09-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}