Interphysician agreement on subclassification of myocardial infarction.
Interphysician agreement on subclassification of myocardial infarction.
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DOI：
10.1136/heartjnl-2017-312409
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Baron T
中科院分区：
文献类型：
--
作者：
Gard A;Lindahl B;Batra G;Hadziosmanovic N;Hjort M;Szummer KE;Baron T
心肌梗死（MI）的通用定义区分了由于氧供应/需求不匹配（2型）导致的MI与由于斑块破裂（1型）导致的MI以及非缺血性或多因素性质的心肌损伤。本研究的目的是调查医生同意这种分类的频率以及导致同意或不同意的因素。2011年，在8家不同的瑞典医院共纳入了1328例诊断为MI的患者。所有患者由两名独立的受过专门训练的医生严格按照MI的第三种通用定义回顾性地重新分类为不同的MI或心肌损伤亚型。总体而言，在该分类中，观察者间一致性为中度，kappa系数（κ）为0.55。在区分1型MI时基本一致（κ：0.61），而在区分2型MI时中度一致（κ：0.54）。在多变量logistic回归分析中，ST段抬高型MI（P<0.001），行冠状动脉造影（P<0.001）和肌钙蛋白水平的较大变化（P=0.023）独立地使医生更经常同意，而他们更经常不同意呼吸困难的症状入院时收缩压升高（P = 0.001），C反应蛋白升高（P=0.016）。区分MI类型对于训练有素的裁定者也是一项挑战。虽然严格遵守MI的第三个通用定义，但1型MI、2型MI和心肌损伤之间的区分仅得到中等程度的观察者间一致性。目前迫切需要更精确和临床适用的分类标准，特别是2型MI诊断标准。
The 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. A 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. Overall, there was a moderate interobserver agreement with a kappa coefficient (κ) of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (κ: 0.61), compared with moderate agreement when distinguishing type 2 MI (κ: 0.54). In multivariate logistic regression analyses, ST elevation MI (P<0.001), performed coronary angiography (P<0.001) and larger changes in troponin levels (P=0.023) independently made the physicians agree significantly more often, while they disagreed more often with symptoms of dyspnoea (P<0.001), higher systolic blood pressure (P=0.001) and higher C reactive protein levels on admission (P=0.016). Distinguishing MI types is challenging also for trained adjudicators. Although strictly adhering to the third universal definition of MI, differentiation between type 1 MI, type 2 MI and myocardial injury only gave a moderate rate of interobserver agreement. More precise and clinically applicable criteria for the current classification, particularly for type 2 MI diagnosis, are urgently needed.
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影响因子：
5.9
作者：
Shah, Anoop S. V.;McAllister, David A.;Mills, Rosamund;Lee, Kuan Ken;Churchhouse, Antonia M. D.;Fleming, Kathryn M.;Layden, Elizabeth;Anand, Atul;Fersia, Omar;Joshi, Nikhil V.;Walker, Simon;Jaffe, Allan S.;Fox, Keith A. A.;Newby, David E.;Mills, Nicholas L.
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影响因子：
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5.9
作者：
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通讯作者：
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影响因子：
2.5
作者：
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通讯作者：
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影响因子：
5.9
作者：
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通讯作者：
Mickley, Hans