Differences in postoperative myocardial infarction rates when comparing NSQIP and the universal 2012 definitions
Abstract
Objective: The definition of myocardial infarction (MI) may impact the number and clinical significance of postoperative MI rates. We compared rates of postoperative MI using the current National Surgery Quality Improvement... [ view full abstract ]
Objective: The definition of myocardial infarction (MI) may impact the number and clinical significance of postoperative MI rates. We compared rates of postoperative MI using the current National Surgery Quality Improvement Program (NSQIP) and the 2012 Universal definitions of MI.
Methods: All NSQIP assessed postoperative MI occurrences from 2013-2015 at a single institution were identified. The NSQIP definition of MI required one of the following: troponin 3-times the upper limit of normal (ULN), EKG changes, or charted physician diagnosis. The 2012 Universal definition required troponin above the ULN and one of the following: ischemic symptoms, EKG changes, imaging abnormalities, or angiographic confirmation. The 2012 Universal definition was applied with patient- and procedure-specific characteristics compared by MI definition using Chi-Square tests.
Results: Of 81 patients identified meeting the NSQIP definition only 42 (51.8%) met the 2012 Universal definition of MI. Patients meeting the 2012 universal definition were more likely to have ischemic EKG changes (55.5% vs. 22.2%; p<0.01) and ischemic symptoms (71.4% vs. 23.1%; p=0.01) compared to those meeting the NSQIP definition alone. The median peak troponin in patients meeting only the NSQIP definition was 0.99 ng/ml. Postoperative coronary angiography was more often pursued in patients meeting the 2012 universal definition compared to the NSQIP definition (40.5% vs. 5.1%; p<0.01).
Conclusion:
Only half of patients with a MI defined by the current NSQIP definition met the 2012 universal MI definition. The current NSQIP definition may over-estimate true coronary events. Further consideration to update and reclassify NSQIP’s MI definition may be warranted.
Authors
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Robert Hollis
(University of Alabama at Birmingham)
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Kevin Shrestha
(University Of Alabama At Birmingham, Department Of Surgery)
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Tyler Wahl
(University of Alabama at Birmingham)
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Daniel I. Chu
(University of Alabama at Birmingham)
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Joshua S. Richman
(University Of Alabama At Birmingham, Department Of Surgery, Division of Gastrointestinal Surgery)
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James Kirklin
(University of Alabama at Birmingham)
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Melanie S. Morris
(University of Alabama at Birmingham)
Topic Area
General Surgery
Session
QS-GS/CRS » Quick-Shot Presentations: General / Colorectal Surgery (15:00 - Thursday, 21st September, Ireland 406)