Background
International Classification of Disease (ICD) codes are central for identifying myocardial
infarction (MI) in administrative hospitalisation data, however validation of MI subtype
codes is limited. We measured the sensitivity and specificity of ICD-10-AM (Australian
Modification) codes for ST-elevation MI (STEMI) and non-STEMI (NSTEMI).
Methods
A sample of MI admissions was obtained from a dataset containing all MI hospitalisations
in Western Australia (WA) for 2003, 2008 and 2013. Clinical data were collected from
hospital medical records (n=799 patients). Cases were classified by ICD-10-AM codes
for STEMI, NSTEMI and unspecified MI, and compared to clinical classification from
review of available electrocardiographs (ECGs) and cardiac biomarkers (n=660). Sensitivity
and specificity for ICD-10-AM coding versus clinical classification was measured,
stratified by calendar year of discharge.
Results
The majority of classifiable cases had MI recorded in the principal diagnosis field
(STEMI n=293, 84.2%; NSTEMI n=202, 74.3%; unspecified MI n=20, 50.0%). Overall sensitivity
of the ICD-10-AM STEMI code was 86.3% (95% CI 81.7–90.0%) and was higher when restricted
to MI as a principal versus secondary diagnosis (88.8% vs 66.7%). Comparable values
for NSTEMI were 66.7% (95% CI 61.5–71.6%), and 68.8% vs 61.4% respectively. Between
2003 and 2013, sensitivity for both MI subtypes increased: 80.2–89.5% for STEMI, and
51.2–73.8% for NSTEMI. Specificity was high for NSTEMI throughout (88.2% 95% CI 84.1–91.6%),
although improving over time for STEMI (68.1–76.4%).
Conclusions
The sensitivity and specificity of ICD-10-AM codes for MI subtypes in hospitalisation
data are generally high, particularly for principal diagnosis cases. However, the
temporal improvement in sensitivity in coding of MI subtypes, particularly NSTEMI,
may necessitate modification to trend studies using administrative hospitalisation
data.
Keywords
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Article info
Publication history
Published online: January 19, 2022
Accepted:
November 20,
2021
Received in revised form:
November 7,
2021
Received:
September 12,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
