News: Fourth universal definition of MI published
As expected, the fourth universal definition of myocardial infarction (MI) has now been released and includes the new concept of “myocardial injury,” according to MedPage Today. The guidelines have been the four-year project of a committee of cardiologists and other healthcare professionals from the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Health Federation.
The new definition emphasizes troponin expression as the main trigger to determine if a person should go to the catheter lab for chest pain that may be a heart attack, MedPage Today reported. Cardiac injury is a rise in troponin without other symptoms or components of MI, according to the new guidelines.
The term acute MI (AMI) “should be used when there is an acute myocardial injury with clinical evidence of acute myocardial ischemia and with detection of a rise and or/fall of cardiac troponin values with at least one value above the 99th percentile upper reference limit,” new recommendations state. Additionally, in order to qualify as an AMI, the patient must have one of the following:
- Symptoms of myocardial ischemia
- New ischemic electrocardiogram changes
- Development of pathological Q waves
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with ischemic etiology
- Identification of a coronary thrombus by angiography or autopsy
These guidelines aim to ensure that patients who arrive in the ED with chest pain aren’t incorrectly labeled with heart attack based on elevated troponin levels alone.
According to James S. Kennedy, MD, CCS, CCDS, CDIP, these new definitions pose no small difficulty for CDI and coding professionals. The article emphasizes the term myocardial injury in non-traumatic circumstances, but ICD-10-CM only classifies the term as traumatic.
CDI professionals should work with their cardiology and coding departments to ensure that patients are not reported as having an AMI when a physician documents “myocardial injury” when they did not have an AMI, Kennedy advices.
Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the complete fourth universal definition of MI, click here. To read Dr. Kennedy’s advice related to these changes, click here. You can listen to Dr. Kennedy’s take on the new definition on the August 29 edition of ACDIS Radio as well.