Interphysician agreement on subclassification of ...

[Pages:16]Heart: first published as 10.1136/heartjnl-2017-312409 on 16 February 2018. Downloaded from on February 1, 2024 by guest. Protected by copyright.

Heart Online First, published on February 16, 2018 as 10.1136/heartjnl-2017-312409 Coronary artery disease

Original research article

Interphysician agreement on subclassification of myocardial infarction

Anton Gard,1,2 Bertil Lindahl,1,2 Gorav Batra,1,2 Nermin Hadziosmanovic,1,2 Marcus Hjort,1,2 Karolina Elisabeth Szummer,3,4 Tomasz Baron1,2

1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden 2Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden 3Department of Medicine, Huddinge, Section of Cardiology, Karolinska Institute, Uppsala, Sweden 4Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

Correspondence to Mr. Anton Gard, Department of Cardiology, Uppsala Clinical Research Center, Uppsala 75185, Sweden; gardanton@ gmail.c om

Received 6 September 2017 Revised 29 December 2017 Accepted 2 January 2018

Abstract ObjectiveThe universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement. MethodsA total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included. All patients were retrospectively reclassified into different MI or myocardial injury subtypes by two independent specially trained physicians, strictly adhering to the third universal definition of MI. Results Overall, there was a moderate interobserver agreement with a kappa coefficient () of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (: 0.61), compared with moderate agreement when distinguishing type 2 MI (: 0.54). In multivariate logistic regression analyses, ST elevation MI (P ................
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