© 2014-2016

Third Universal Definition ofMyocardial Infarction

April 2017

© 2014-2016

Third Universal Definition of Myocardial Infarction

● First Definition - 2000

● Biomarker detection

● Five types of MI

● ICD-10-CM proposed code changes, Oct 2017

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http://circ.ahajournals.org/content/126/16/2020http://circ.ahajournals.org/content/126/16/2020

© 2014-2016

Videos

Exclusive Interview: The Third Universal Definition of MICardioSource (6:43)

2017 Mar 7th, ICD-10 Coordination & Maintenance Committee (Afternoon Session): Classification of Myocardial Infarction(14:24)

The Universal Definition of MI & Troponin: Clearing the Confusion(56:26)

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https://www.youtube.com/watch?v=XqpNFiNTq18https://www.youtube.com/watch?v=XqpNFiNTq18https://www.youtube.com/watch?v=xTPGUl6Zs6I&feature=youtu.behttps://www.youtube.com/watch?v=xTPGUl6Zs6I&feature=youtu.behttps://www.youtube.com/watch?v=xTPGUl6Zs6I&feature=youtu.behttps://www.youtube.com/watch?v=xTPGUl6Zs6I&feature=youtu.behttps://www.youtube.com/watch?v=xTPGUl6Zs6I&feature=youtu.behttps://www.youtube.com/watch?v=wG648kGtEfshttps://www.youtube.com/watch?v=wG648kGtEfs

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© 2014-2016

Third Universal Definition of Myocardial Infarction

● Type 2 MI - Injury related to supply/demand imbalance of myocardial ischemia

● Injury not related to myocardial ischemia

● Multifactorial and indeterminate myocardial injury

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© 2014-2016

Types 1 - 5

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© 2014-2016

Types 1 vs. 2

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Spontaneous Myocardial Infarction (MI Type 1)

This is an event related to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection with resulting intraluminal thrombus in one or more of the coronary arteries, leading to decreased myocardial blood flow or distal platelet emboli with ensuing myocyte necrosis. The patient may have underlying severe CAD but, on occasion (5 to 20%), non-obstructive or no CAD may be found at angiography, particularly in women.23–25

Myocardial Infarction Secondary to an Ischemic Imbalance (MI Type 2)

In instances of myocardial injury with necrosis, where a condition other than CAD contributes to an imbalance between myocardial oxygen supply and/or demand, the term ‘MI type 2’ is employed (Figure 2). In critically ill patients, or in patients undergoing major (non-cardiac) surgery, elevated values of cardiac biomarkers may appear, due to the direct toxic effects of endogenous or exogenous high circulating catecholamine levels. Also coronary vasospasm and/or endothelial dysfunction have the potential to cause MI.

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Proposed ICD-10-CM Code Modifications

© 2014-201613

ICD-10-CM: Type 2 MI, I21.A1

© 2014-201614

AHA Coding Clinic, Q1, 2017: Type 2 MI

© 2014-201615

nSight Formula: Type 2 MI undocumented

© 2014-201616

HCUPnet 2014 - PDX 410.71

https://hcupnet.ahrq.gov/#setuphttps://hcupnet.ahrq.gov/#setup

© 2014-201617

T2MI vs Myocardial Injury

http://jamanetwork.com/journals/jamacardiology/fullarticle/2518764http://jamanetwork.com/journals/jamacardiology/fullarticle/2518764

© 2014-2016

Follow-up

Tom Scholomiti, RHITSr. Director, nSight Strategy and ImplementationRecordsOne, LLCNaples, FL

(518) 209-1374tom@recordsone.com

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