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ADDITIONAL FILESeTable 1. Variables, Types of Codes, and Corresponding CodeseTable 2. Definitions of ICU and HCUeTable 3. Patient Characteristics by Admission to the ICU&HCU vs wards (Sensitivity Analysis by re-grouping HCU as a part of ICU group)eTable 4. Patient Characteristics by Admission to the ICU vs non-ICU (Sensitivity Analysis by different AMI definition)eTable 5. Patient Characteristics by Admission to the ICU vs non-ICU (Sensitivity Analysis limited to hospitals with ICU)eTable 6. Patient Characteristics by Admission to the ICU vs non-ICU(Sensitivity Analysis limited to Killip 1,2,3)eTable 1. Variables, Types of Codes, and Corresponding CodesVariablesTypes of CodesCodes/AlgorithmsAMIICD-10I210, I211, I212, I213, I214, I219ICU admissionclaims code (K-code)A3001, A3002, A3003, A3004,A3011, A3012, A3013, A3014HCU admissionclaims code (K-code)A301-21, A301-22CCIICD-10CCI=cMI+cCHF+cPVD+cCVD+cDeme+cCPD+cRheu+cPUD+cMLD+cDM+2*cDMC+2*cPLE+2*cRD+2*cMAL+3*cSLD+6*cMETA+6*cHIV aHTICD-10I10DMICD-10E10, E11, E12, E13, E14DLICD-10E78RFICD-10N17, N18, N19OMIICD-10I252STEMIICD-10I210, I211, I212, I213Anterior MIICD-10I210Off-hour admissionclaims code (R-code)113011610, 113013710, 113013810, 140000190, 140000290, 140000390, 140000490, 140055290, 140055390, 140055490, 140055590, 150000490, 150000590, 150000690, 150000790, 150371290, 150371390, 150371490, 150371590Ambulance usePayload codeA000020-6 = 1ReferralPayload codeA000020-3 = 1PCIclaims code (K-code)K546, K549D2B time < 90minclaims code (K-code)K546-1, K549-1FibrinolyticATC codeB01D0CABGclaims code (K-code)K552, K552-2CatecholamineATC codeC01CIABPclaims code (K-code)K600PCPSclaims code (K-code)K602Ventilatorclaims code (K-code)J045AspirinATC codeB01C1, B01C5, B01C9StatinATC codeC10A1, C11A1Beta-blockerATC codeC07A, C07B, C07CACE-I/ARBATC codeC09A, C09B, C09D30-day mortalityPayload codeA000030-3 = 6, 7 AND Period_Admission <= 30Length of hospital stayPayload codePeriod_Admission=DATDIF(A000020-1, A000030-1, 'act/act')AMI, acute myocardial infarction; ICD, international classification of disease; ICU, intensive care unit; HCU, high care unit; CCI, Charlson comorbidity index; HT, hypertension; DM, diabetes mellitus; DL, dyslipidemia; RF, renal failure; OMI, old myocardial infarction; STEMI, ST-elevation myocardial infarction; MI, myocardial infarction; PCI, percutaneous coronary intervention; D2B, door to balloon; ATC, anatomical therapeutic chemical; CABG, coronary artery bypass graft; IABP, intra-aortic balloon pump; PCPS, percutaneous cardio-pulmonary support; ACE-I/ARB, angiotensin-converting enzyme inhibitor/angiotensin 2 receptor blockera See reference 16 for the detaileTable 2. Definitions of ICU and HCU　ICUHCUStaffingAt least one full-time intensivist is present in the unit at all timeMinimum nurse to patient ratio of 1:2At least one full-time doctor is present in the hospital at all timeMinimum nurse to patient ratio of 1:5Floor areaSpecialized unit with floor area of more than 15 square meter per bedNo regulationDevicesResuscitation kit (eg. Intubation kit, mechanical ventilator), defibrillator, pace-maker, electrocardiogram, portable X-ray, cardio/respiratory monitoringResuscitation kit (eg. Intubation kit, mechanical ventilator), defibrillator, electrocardiogram, cardio/respiratory monitoringHospital structureEquipped with a private in-house power generatorLab exam (eg blood gas and electrolyte analysis) availabilityThe unit is bio-clean roomEmergency operation capabilityNo regulationPatientsAltered mental status or coma, acute respiratory failure or acute exacerbation of chronic respiratory failure, acute heart failure (including AMI), acute toxic syndrome, shock, severe metabolic dysfunction (eg hepatic failure, renal failure, severe diabetes), extensive burn, post major operation, post resuscitation, severe trauma or tetanusPatients with "severity and medical/nursing needs for ICU" exceeding 3 points in category A and 3 points in category B account for more than 80% of patients in the unit.Altered mental status or coma, acute respiratory failure or acute exacerbation of chronic respiratory failure, acute heart failure (including AMI), acute toxic syndrome, shock, severe metabolic dysfunction (eg hepatic failure, renal failure, severe diabetes), extensive burn, post major operation, post resuscitation, severe trauma or tetanusPatients with "severity and medical/nursing needs for HCU" exceeding 3 points in category A and 3 points in category B account for more than 60% of patients in the unit.Severity and medical/nursing needs*Category A: monitoring and management1. electrocardiogram2. drip infusion pump3. continuous arterial pressure4. syringe infusion pump5. central venous pressure6. ventilator7. blood products8. pulmonary artery pressure9. other special devices (eg CHDF, IABP, PCPS, VAD, ICP, ECMO)Category B: patient condition10. turn over11. stand-up12. keep sitting position13. transfer14. oral hygieneCategory A: monitoring and management1. wound care2. resuscitative measures3. respiratory care (except suction and ventilator management)4. more than 3 IV lines5. electrocardiogram6. drip infusion pump7. continuous arterial pressure8. syringe infusion pump9. central venous pressure10. ventilator11. blood products12. pulmonary artery pressure13. other special devices (eg CHDF, IABP, PCPS, VAD, ICP, ECMO)Category B: patient condition14. bed rest15. bring one hand to the chest16. turn over17. stand-up18. keep sitting position19. transfer20. need for assistance on transfer21. oral hygiene22. eating23. changing clothes24. communication25. understanding orders26. dangerous behaviorICU, intensive care unit; HCU, high care unit; AMI, acute myocardial infarction; CHDF, continuous hemodiafiltration; IABP, intra-aortic balloon pump; PCPS, percutaneous cardiopulmonary support; VAD, ventricular assist device; ICP, intracranial pressure; ECMO, extracorporeal membrane oxygenation; IV, intravenous.*One point is given for management/monitoring of products/devices listed in category A. One point is given if patients are unable to do things listed in category B except for 10, 12, and 13 in ICU and 16, 18, 19, 22, 23, and 24 in HCU. Points for exceptions are as follows: 0pt possible or possible without assistance, 1pt possible with assistance or partial assistance, 2pt impossible or need full assistance.eTable 3. Patient Characteristics by Admission to the ICU&HCU vs wards(Sensitivity analysis by re-grouping HCU as a part of ICU group)Patients, No. (%)CharacteristicsICU&HCUwardsPatients, No.136985047Male10268 (75)3556 (70)Age, mean (SD), y69 (13)71 (13)? <40191 (1)66 (1)? 40-491067 (8)335 (7)? 50-591954 (14)619 (12)? 60-693619 (26)1180 (23)? 70-793706 (27)1401 (28)? ≥803161 (23)1446 (29)CCI, median (IQR)3 (2, 4)3 (2, 4)Smoking history8437 (62)2710 (54)HT10078 (74)3626 (72)DM4875 (36)1734 (34)DL9679 (71)3277 (65)RF951 (7)379 (8)OMI1648 (12)578 (11)STEMI11502 (84)3885 (77)Anterior MI5435 (40)1896 (38)Killip? 16285 (46)2374 (47)? 23807 (28)1390 (28)? 31243 (9)487 (10)? 41936 (14)580 (11)? unknown427 (3)216 (4)Referral5459 (40)2069 (41)Ambulance9463 (69)2846 (56)Off-hour admission6562 (48)1682 (33)PCI12186 (89)3664 (73)D2B time < 90min7780 (57)1814 (36)Fibrinolytic52 (0.4)19 (0.4)CABG338 (2)16 (0.3)IABP2392 (17)344 (7)PCPS366 (3)43 (1)Ventilator2309 (17)414 (8)Catecholamine4067 (30)1041 (21)ICU, intensive care unit; CCI, Charlson comorbidity index; HT, hyptertension; DM, diabetes mellitus; DL, dyslipidemia; RF, renal failure; OMI, old myocardial infarction; STEMI, ST-elevation myocardial infarction; MI, myocardial infarction; PCI, percutaneous coronary intervention; D2B, door to balloon; CABG, coronary artery bypass graft; IABP, intra-aortic balloon pump; PCPS, percutaneous cardio-pulmonary support.eTable 4 Patient Characteristics by Admission to the ICU vs non-ICU(Sensitivity analysis by different AMI definition)Patients, No. (%)CharacteristicsICUnon-ICUPatients, No.1506514069Male10888 (72)9536 (68)Age, mean (SD), years69 (14)71 (14)? <40285 (2)287 (2)? 40-491090 (7)860 (6)? 50-591974 (13)1616 (11)? 60-693753 (25)3222 (23)? 70-794148 (28)3999 (28)? ≥803815 (25)4085 (29)CCI, median (IQR)3 (2, 4)3 (2, 4)Smoking History9181 (61)7511 (53)HT10056 (67)8221 (58)DM5203 (35)4308 (31)DL9285 (62)7065 (50)RF1164 (8)927 (7)OMI1611 (11)1318 (9)STEMI9990 (66)5637 (40)Anterior MI5125 (34)3125 (22)Killip? 16404 (43)6259 (44)? 23569 (24)3101 (22)? 31322 (9)982 (7)? 42202 (15)1508 (11)? unknown1568 (10)2219 (16)Referral6159 (41)6372 (45)Ambulance10310 (68)6540 (46)Off-hour admission6654 (44)3284 (23)PCI11275 (75)6985 (50)D2B time < 90min7026 (47)3037 (22)Fibrinolytic70 (0.5)43 (0.3)CABG546 (4)41 (0.3)IABP2568 (17)702 (5)PCPS511 (3)105 (1)Ventilator3437 (23)1377 (10)Catecholamine4853 (32)2254 (16)ICU, intensive care unit; CCI, Charlson comorbidity index; HT, hypertension; DM, diabetes mellitus; DL, dyslipidemia; RF, renal failure; OMI, old myocardial infarction; STEMI, ST-elevation myocardial infarction; MI, myocardial infarction; PCI, percutaneous coronary intervention; D2B, door to balloon; CABG, coronary artery bypass graft; IABP, intra-aortic balloon pump; PCPS, percutaneous cardio-pulmonary support.eTable 5 Patient Characteristics by Admission to the ICU vs non-ICU(Sensitivity analysis limited to hospitals with ICU)Patients, No. (%)CharacteristicsICUnon-ICUPatients, No.115372582Male8692 (75)1822 (71)Age, mean (SD), years69 (13)70 (13)? <40166 (1)28 (1)? 40-49919 (8)192 (7)? 50-591667 (14)330 (13)? 60-693056 (26)625 (24)? 70-793119 (27)733 (28)? ≥802610 (23)674 (26)CCI, median (IQR)3 (2, 4)3 (2, 4)Smoking history7164 (62)1447 (56)HT8481 (74)1913 (74)DM4170 (36)873 (34)DL8177 (71)1758 (68)RF796 (7)202 (8)OMI1359 (12)281 (11)STEMI9847 (85)1939 (75)Anterior MI4646 (40)883 (34)Killip? 15367 (47)1243 (48)? 23102 (27)798 (31)? 31053 (9)213 (8)? 41613 (14)234 (9)? Unknown402 (3)94 (4)Referral4627 (40)1194 (46)Ambulance8059 (70)1471 (57)Off-hour admission5667 (49)741 (29)PCI10271 (89)1763 (68)D2B time < 90min6695 (58)769 (30)Fibrinolytic47 (0.4)8 (0.3)CABG330 (3)16 (1)IABP2140 (19)110 (4)PCPS339 (3)19 (1)Ventilator2018 (17)154 (6)Catecholamine3589 (31)404 (16)ICU, intensive care unit; CCI, Charlson comorbidity index; HT, hypertension; DM, diabetes mellitus; DL, dyslipidemia; RF, renal failure; OMI, old myocardial infarction; STEMI, ST-elevation myocardial infarction; MI, myocardial infarction; PCI, percutaneous coronary intervention; D2B, door to balloon; CABG, coronary artery bypass graft; IABP, intra-aortic balloon pump; PCPS, percutaneous cardio-pulmonary support.One case was excluded due to miscoding.eTable 6 Patient Characteristics by Admission to the ICU vs non-ICU(Sensitivity analysis limited to Killip 1,2,3)Patients, No. (%)CharacteristicsICUnon-ICUPatients, No.95226064Male7175 (75)4354 (72)Age, mean (SD), years68 (13)70 (13)? <40150 (2)84 (1)? 40-49785 (8)424 (7)? 50-591384 (15)793 (13)? 60-692539 (27)1501 (25)? 70-792578 (27)1660 (27)? ≥802086 (22)1602 (26)CCI, median (IQR)3 (2, 4)3 (2, 4)Smoking history5923 (62)3373 (56)HT7354 (77)4517 (74)DM3482 (37)2068 (34)DL7173 (75)4191 (69)RF564 (6)397 (7)OMI1143 (12)742 (12)STEMI8205 (86)4697 (77)Anterior MI3839 (40)2246 (37)Killip? 15367 (56)3292 (54)? 23102 (33)2095 (35)? 31053 (11)677 (11)? 40 (0)0 (0)? Unknown0 (0)0 (0)Referral3907 (41)2512 (41)Ambulance6477 (68)3473 (57)Off-hour admission4655 (49)2174 (36)PCI8539 (90)4768 (79)D2B time < 90min5387 (57)2303 (38)Fibrinolytic40 (0.4)20 (0.3)CABG238 (3)17 (0.3)IABP1084 (11)269 (4)PCPS69 (0.7)18 (0.3)Ventilator1043 (11)367 (6)Catecholamine2273 (24)995 (16)ICU, intensive care unit; CCI, Charlson comorbidity index; HT, hypertension; DM, diabetes mellitus; DL, dyslipidemia; RF, renal failure; OMI, old myocardial infarction; STEMI, ST-elevation myocardial infarction; MI, myocardial infarction; PCI, percutaneous coronary intervention; D2B, door to balloon; CABG, coronary artery bypass graft; IABP, intra-aortic balloon pump; PCPS, percutaneous cardio-pulmonary support. ................
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