{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T10:16:18Z","timestamp":1774260978386,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Canadian Institutes for Health Research","award":["201809PJT-409935-HS1-CBBA-114817"],"award-info":[{"award-number":["201809PJT-409935-HS1-CBBA-114817"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The fourth universal definition of myocardial infarction (MI) introduced the differentiation of acute myocardial injury from MI. In this study, we developed a computational phenotype for distinct identification of acute myocardial injury and MI within electronic medical records (EMRs). Methods: Two cohorts were used from a Calgary-wide EMR system: a chart review of 3042 randomly selected inpatients from Dec 2014 to Jun 2015; and 11,685 episodes of care that included cardiac catheterization from Jan 2013 to Apr 2017. Electrocardiogram (ECG) reports were processed using natural language processing and combined with high-sensitivity troponin lab results to classify patients as having an acute myocardial injury, MI, or neither. Results: For patients with an MI diagnosis, only 64.0% (65.7%) in the catheterized cohorts (chart review cohort) had two troponin measurements within 6 h of each other. For patients with two troponin measurements within 6 h; of those with an MI diagnosis, our phenotype classified 25.2% (31.3%) with an acute myocardial injury and 62.2% (55.2%) with an MI in the catheterized cohort (chart review cohort); and of those without an MI diagnosis, our phenotype classified 12.9% (12.4%) with an acute myocardial injury and 10.0% (13.1%) with an MI in the catheterized cohort (chart review cohort). Conclusions: Patients with two troponin measurements within 6 h, identified by our phenotype as having either an acute myocardial injury or MI, will at least meet the diagnostic criteria for an acute myocardial injury (barring lab errors) and indicate many previously uncaptured cases. Myocardial infarctions are harder to be certain of because ECG report findings might be superseded by evidence not included in our phenotype, or due to errors with the natural language processing.<\/jats:p>","DOI":"10.3390\/jcm13247773","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T10:54:20Z","timestamp":1734605660000},"page":"7773","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Developing a Computational Phenotype of the Fourth Universal Definition of Myocardial Infarction for Inpatients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5127-4333","authenticated-orcid":false,"given":"Elliot A.","family":"Martin","sequence":"first","affiliation":[{"name":"Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"},{"name":"Provincial Research Data Services, Alberta Health Services, Calgary, AB T2N 4Z6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2760-8967","authenticated-orcid":false,"given":"Bryan","family":"Har","sequence":"additional","affiliation":[{"name":"Alberta Health Services, Calgary, AB T3B 0N9, Canada"},{"name":"Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin L.","family":"Walker","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"},{"name":"Alberta Health Services, Calgary, AB T3B 0N9, Canada"},{"name":"Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0006-0033","authenticated-orcid":false,"given":"Danielle A.","family":"Southern","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"},{"name":"Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-7256","authenticated-orcid":false,"given":"Hude","family":"Quan","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"},{"name":"Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy A.","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"},{"name":"Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.jacc.2018.08.1038","article-title":"Fourth Universal Definition of Myocardial Infarction (2018)","volume":"72","author":"Thygesen","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1093\/eurheartj\/ehs184","article-title":"Third Universal Definition of Myocardial Infarction","volume":"33","author":"Thygesen","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.amjmed.2015.12.009","article-title":"Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions","volume":"129","author":"Sarkisian","year":"2016","journal-title":"Am. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.amjmed.2017.11.043","article-title":"Different Causes of Death in Patients with Myocardial Infarction Type 1, Type 2, and Myocardial Injury","volume":"131","author":"Lambrecht","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1161\/CIRCULATIONAHA.117.031806","article-title":"Long-Term Outcomes in Patients with Type 2 Myocardial Infarction and Myocardial Injury","volume":"137","author":"Chapman","year":"2018","journal-title":"Circulation"},{"key":"ref_6","first-page":"10","article-title":"Assessment and Classification of Patients with Myocardial Injury and Infarction in Clinical Practice","volume":"103","author":"Chapman","year":"2017","journal-title":"Heart Br. Card. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1136\/heartjnl-2019-315036","article-title":"Acute versus Chronic Myocardial Injury and Long-Term Outcomes","volume":"105","author":"Roos","year":"2019","journal-title":"Heart"},{"key":"ref_8","unstructured":"(2021, December 30). Allscripts\u00a9 Sunrise Clinical Manager. Available online: https:\/\/ca.allscripts.com\/solution\/ehr\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.cjco.2020.12.019","article-title":"CREATE: A New Data Resource to Support Cardiac Precision Health","volume":"3","author":"Lee","year":"2021","journal-title":"CJC Open"},{"key":"ref_10","first-page":"1225","article-title":"Overview of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease. On Behalf of the APPROACH Investigators","volume":"16","author":"Ghali","year":"2000","journal-title":"Can. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Southern, D.A., Norris, C.M., Quan, H., Shrive, F.M., Galbraith, P.D., Humphries, K., Gao, M., Knudtson, M.L., Ghali, W.A., and the APPROACH Investigators (2008). An Administrative Data Merging Solution for Dealing with Missing Data in a Clinical Registry: Adaptation from ICD-9 to ICD-10. BMC Med. Res. Methodol., 8.","DOI":"10.1186\/1471-2288-8-1"},{"key":"ref_12","unstructured":"(2022, January 03). Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH).(n.d.). Available online: https:\/\/approach.org."},{"key":"ref_13","unstructured":"(2024, November 07). Discharge Abstract Database (DAD) Metadata|CIHI. Available online: https:\/\/www.cihi.ca\/en\/discharge-abstract-database-dad-metadata."},{"key":"ref_14","unstructured":"(2024, November 07). National Ambulatory Care Reporting System (NACRS) Metadata|CIHI. Available online: https:\/\/www.cihi.ca\/en\/national-ambulatory-care-reporting-system-nacrs-metadata."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Eastwood, C.A., Southern, D.A., Khair, S., Doktorchik, C., Cullen, D., Ghali, W.A., and Quan, H. (2022). Field Testing a New ICD Coding System: Methods and Early Experiences with ICD-11 Beta Version 2018. BMC Res. Notes, 15.","DOI":"10.1186\/s13104-022-06238-2"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1111\/j.1475-6773.2007.00822.x","article-title":"Assessing Validity of ICD-9-CM and ICD-10 Administrative Data in Recording Clinical Conditions in a Unique Dually Coded Database","volume":"43","author":"Quan","year":"2008","journal-title":"Health Serv. Res."},{"key":"ref_17","unstructured":"WHO (2021, December 30). International Classification of Diseases. (n.d.). Available online: https:\/\/icd.who.int\/en."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1093\/eurheartj\/ehs154","article-title":"How to Use High-Sensitivity Cardiac Troponins in Acute Cardiac Care","volume":"33","author":"Thygesen","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1373\/clinchem.2011.171827","article-title":"Absolute and Relative Kinetic Changes of High-Sensitivity Cardiac Troponin T in Acute Coronary Syndrome and in Patients with Increased Troponin in the Absence of Acute Coronary Syndrome","volume":"58","author":"Mueller","year":"2012","journal-title":"Clin. Chem."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1161\/CIRCULATIONAHA.111.023937","article-title":"Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction","volume":"124","author":"Reichlin","year":"2011","journal-title":"Circulation"},{"key":"ref_22","unstructured":"Stubblebine, T. (2003). Regular Expression Pocket Reference, O\u2019Reilly Media, Inc."},{"key":"ref_23","unstructured":"Martin, E.A. (2022, January 04). ECG Extraction Code. Available online: https:\/\/github.com\/centre-for-health-informatics\/ECG_Extract."},{"key":"ref_24","unstructured":"Sokal, R.R., and Michener, C.D. (1958). A Statistical Method for Evaluating Systematic Relationships, University of Kansas."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1373\/clinchem.2010.158964","article-title":"Biological Variation and Reference Change Value of High-Sensitivity Troponin T in Healthy Individuals during Short and Intermediate Follow-up Periods","volume":"57","author":"Frankenstein","year":"2011","journal-title":"Clin. Chem."},{"key":"ref_26","unstructured":"Pizarro, J. (2022, August 15). Negspacy: Negation for spaCy 2022. Available online: https:\/\/github.com\/jenojp\/negspacy."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1006\/jbin.2001.1029","article-title":"A Simple Algorithm for Identifying Negated Findings and Diseases in Discharge Summaries","volume":"34","author":"Chapman","year":"2001","journal-title":"J. Biomed. Inform."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.clinthera.2024.06.010","article-title":"Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Acute Coronary Syndrome: A Modern Cinderella?","volume":"46","author":"Karakasis","year":"2024","journal-title":"Clin. Ther."},{"key":"ref_29","unstructured":"Observational Health Data Sciences and Informatics (2019). The Book of OHDSI: Observational Health Data Sciences and Informatics, OHDSI."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7773\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:55:50Z","timestamp":1760115350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,19]]},"references-count":29,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247773"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247773","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,19]]}}}