{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:41:10Z","timestamp":1790995270013,"version":"4.1.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,4,3]]},"abstract":"\n Background<\/jats:title>\n \n The\n International Classification of Diseases (ICD)<\/jats:italic>\n coding system does not recognize type 2 myocardial infarction (\n MI<\/jats:styled-content>\n ) as a separate entity; therefore, patients with type 2\n MI<\/jats:styled-content>\n continue to be categorized under the general umbrella of non\u2013ST\u2010segment\u2013elevation myocardial infarction (\n NSTEMI)<\/jats:styled-content>\n . We aim to evaluate the impact of type 2\n MI<\/jats:styled-content>\n on hospital\u2010level\n NSTEMI<\/jats:styled-content>\n metrics and discuss the implications for quality and public reporting.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We conducted a single\u2010center retrospective analysis of 1318 patients discharged with a diagnosis of\n NSTEMI<\/jats:styled-content>\n between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2\n MI<\/jats:styled-content>\n . Weighted Kaplan\u2013Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met\n NSTEMI<\/jats:styled-content>\n criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2\n MI<\/jats:styled-content>\n . Patients with type 2\n MI<\/jats:styled-content>\n 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\n MI<\/jats:styled-content>\n had higher inpatient mortality (17.4% versus 4.7%,\n P<\/jats:italic>\n <0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%,\n P<\/jats:italic>\n <0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2\n MI<\/jats:styled-content>\n had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67\u20137.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44\u20132.73) after discharge. Type 2\n MI<\/jats:styled-content>\n was also associated with a lower 30\u2010day cardiovascular\u2010related readmission (risk ratio: 0.49; 95% confidence interval, 0.12\u20132.06).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n NSTEMI<\/jats:styled-content>\n metrics are significantly affected by type 2\n MI<\/jats:styled-content>\n patients. Type 2\n MI<\/jats:styled-content>\n patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1\n MI<\/jats:styled-content>\n . Moving forward, it may be appropriate to exclude type 2\n MI<\/jats:styled-content>\n data from\n NSTEMI<\/jats:styled-content>\n quality metrics.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008661","type":"journal-article","created":{"date-parts":[[2018,3,26]],"date-time":"2018-03-26T09:05:13Z","timestamp":1522055113000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":55,"title":["Impact of Type 2 Myocardial Infarction (MI) on Hospital\u2010Level MI Outcomes: Implications for Quality and Public Reporting"],"prefix":"10.1161","volume":"7","author":[{"given":"Sameer","family":"Arora","sequence":"first","affiliation":[{"name":"Division of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula D.","family":"Strassle","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arman","family":"Qamar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan N.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Campbell University School of Osteopathic Medicine, Lillington, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra L.","family":"Levine","sequence":"additional","affiliation":[{"name":"Campbell University School of Osteopathic Medicine, Lillington, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob A.","family":"Misenheimer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Cavender","sequence":"additional","affiliation":[{"name":"Division of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Stouffer","sequence":"additional","affiliation":[{"name":"Division of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Kaul","sequence":"additional","affiliation":[{"name":"Division of Cardiology and McAllister Heart Institute, University of North Carolina at Chapel Hill, NC"},{"name":"Piedmont Heart Institute, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.187397"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826e1058"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.11.035"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.023052"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.05.045"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx457"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000133"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406656"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2003.10.004"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.04.010"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.11.031"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.14.1611"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs191"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1159\/000110491"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-013-0591-0"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2008.11.004"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2014.0019"},{"key":"e_1_3_2_19_2","first-page":"858496","article-title":"The harmful effects of subarachnoid hemorrhage on extracerebral organs","volume":"2014","author":"Chen S","year":"2014","unstructured":"Chen S, Li Q, Wu H, Krafft PR, Wang Z, Zhang JH. 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