• Andrija Matetic, Gemina Doolub, Van SpallHarriette G CHGCDepartment of Medicine, McMaster University, Hamilton, ON, Canada.Population Health Research Institute, Hamilton, ON, Canada.ICES, Hamilton, ON, Canada., Mohamad Alkhouli, Hude Quan, Sonia Butalia, Phyo K Myint, Rodrigo Bagur, Tiberiu A Pana, Mohamed O Mohamed, and Mamas A Mamas.
• Department of Cardiology, University Hospital of Split, Split, Croatia.
• Int. J. Clin. Pract. 2021 Oct 1; 75 (10): e14554.

BackgroundIn recent years, there has been a growing interest in outcomes of patients with acute myocardial infarction (AMI) using large administrative datasets. The present study was designed to compare the characteristics, management strategies and acute outcomes between patients with primary and secondary AMI diagnoses in a national cohort of patients.MethodsAll hospitalisations of adults (≥18 years) with a discharge diagnosis of AMI in the US National Inpatient Sample from January 2004 to September 2015 were included, stratified by primary or secondary AMI. The International Classification of Diseases, ninth revision and Clinical Classification Software codes were used to identify patient comorbidities, procedures and clinical outcomes.ResultsA total of 10 864 598 weighted AMI hospitalisations were analysed, of which 7 186 261 (66.1%) were primary AMIs and 3 678 337 (33.9%) were secondary AMI. Patients with primary AMI diagnoses were younger (median 68 vs 74 years, P < .001) and less likely to be female (39.6% vs 48.5%, P < .001). Secondary AMI was associated with lower odds of receipt of coronary angiography (aOR 0.19; 95%CI 0.18-0.19) and percutaneous coronary intervention (0.24; 0.23-0.24). Secondary AMI was associated with increased odds of MACCE (1.73; 1.73-1.74), mortality (1.71; 1.70-1.72), major bleeding (1.64; 1.62-1.65), cardiac complications (1.69; 1.65-1.73) and stroke (1.68; 1.67-1.70) (P < .001 for all).ConclusionsSecondary AMI diagnoses account for one-third of AMI admissions. Patients with secondary AMI are older, less likely to receive invasive care and have worse outcomes than patients with a primary diagnosis code of AMI. Future studies should consider both primary and secondary AMI diagnoses codes in order to accurately inform clinical decision-making and health planning.© 2021 John Wiley & Sons Ltd.

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