Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/217298 |
Resumo: | Background Physicians commonly judge whether a myocardial infarction (MI) is type 1 (thrombotic) vs type 2 (supply/demand mismatch) based on clinical information. Little is known about the accuracy of physicians’ clinical judgement in this regard. We aimed to determine the accuracy of physicians’ judgement in the classification of type 1 vs type 2 MI in perioperative and nonoperative settings. Methods We performed an online survey using cases from the Optical Coherence Tomographic Imaging of Thrombus (OPTIMUS) Study, which investigated the prevalence of a culprit lesion thrombus based on intracoronary optical coherence tomography (OCT) in patients experiencing MI. Four MI cases, 2 perioperative and 2 nonoperative, were selected randomly, stratified by etiology. Physicians were provided with the patient’s medical history, laboratory parameters, and electrocardiograms. Physicians did not have access to intracoronary OCT results. The primary outcome was the accuracy of physicians' judgement of MI etiology, measured as raw agreement between physicians and intracoronary OCT findings. Fleiss’ kappa and Gwet’s AC1 were calculated to correct for chance. Results The response rate was 57% (308 of 536). Respondents were 62% male; median age was 45 years (standard deviation ± 11); 45% had been in practice for > 15 years. Respondents’ overall accuracy for MI etiology was 60% (95% confidence interval [CI] 57%-63%), including 63% (95% CI 60%-68%) for nonoperative cases, and 56% (95% CI 52%-60%) for perioperative cases. Overall chance-corrected agreement was poor (kappa = 0.05), consistent across specialties and clinical scenarios. Conclusions Physician accuracy in determining MI etiology based on clinical information is poor. Physicians should consider results from other testing, such as invasive coronary angiography, when determining MI etiology. |
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Borges, Flávia KesslerAlboim, CarolinaPolanczyk, Carisi AnneDevereaux, Philip J.2021-01-14T04:10:48Z20202589-790Xhttp://hdl.handle.net/10183/217298001120400Background Physicians commonly judge whether a myocardial infarction (MI) is type 1 (thrombotic) vs type 2 (supply/demand mismatch) based on clinical information. Little is known about the accuracy of physicians’ clinical judgement in this regard. We aimed to determine the accuracy of physicians’ judgement in the classification of type 1 vs type 2 MI in perioperative and nonoperative settings. Methods We performed an online survey using cases from the Optical Coherence Tomographic Imaging of Thrombus (OPTIMUS) Study, which investigated the prevalence of a culprit lesion thrombus based on intracoronary optical coherence tomography (OCT) in patients experiencing MI. Four MI cases, 2 perioperative and 2 nonoperative, were selected randomly, stratified by etiology. Physicians were provided with the patient’s medical history, laboratory parameters, and electrocardiograms. Physicians did not have access to intracoronary OCT results. The primary outcome was the accuracy of physicians' judgement of MI etiology, measured as raw agreement between physicians and intracoronary OCT findings. Fleiss’ kappa and Gwet’s AC1 were calculated to correct for chance. Results The response rate was 57% (308 of 536). Respondents were 62% male; median age was 45 years (standard deviation ± 11); 45% had been in practice for > 15 years. Respondents’ overall accuracy for MI etiology was 60% (95% confidence interval [CI] 57%-63%), including 63% (95% CI 60%-68%) for nonoperative cases, and 56% (95% CI 52%-60%) for perioperative cases. Overall chance-corrected agreement was poor (kappa = 0.05), consistent across specialties and clinical scenarios. Conclusions Physician accuracy in determining MI etiology based on clinical information is poor. Physicians should consider results from other testing, such as invasive coronary angiography, when determining MI etiology.application/pdfengCJC open. New York. Vol. 2, no. 6 (2020), p. 577-584Infarto do miocárdioAccuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical informationEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001120400.pdf.txt001120400.pdf.txtExtracted Texttext/plain38981http://www.lume.ufrgs.br/bitstream/10183/217298/2/001120400.pdf.txt61390e5fdbcf26a0998b7eaa58db4913MD52ORIGINAL001120400.pdfTexto completo (inglês)application/pdf465094http://www.lume.ufrgs.br/bitstream/10183/217298/1/001120400.pdf3ecff6afa1bb989c4f38577839a4aa13MD5110183/2172982021-03-09 04:34:55.614789oai:www.lume.ufrgs.br:10183/217298Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2021-03-09T07:34:55Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
title |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
spellingShingle |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information Borges, Flávia Kessler Infarto do miocárdio |
title_short |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
title_full |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
title_fullStr |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
title_full_unstemmed |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
title_sort |
Accuracy of physicians in differentiating type 1 and type 2 myocardial infarction based on clinical information |
author |
Borges, Flávia Kessler |
author_facet |
Borges, Flávia Kessler Alboim, Carolina Polanczyk, Carisi Anne Devereaux, Philip J. |
author_role |
author |
author2 |
Alboim, Carolina Polanczyk, Carisi Anne Devereaux, Philip J. |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Borges, Flávia Kessler Alboim, Carolina Polanczyk, Carisi Anne Devereaux, Philip J. |
dc.subject.por.fl_str_mv |
Infarto do miocárdio |
topic |
Infarto do miocárdio |
description |
Background Physicians commonly judge whether a myocardial infarction (MI) is type 1 (thrombotic) vs type 2 (supply/demand mismatch) based on clinical information. Little is known about the accuracy of physicians’ clinical judgement in this regard. We aimed to determine the accuracy of physicians’ judgement in the classification of type 1 vs type 2 MI in perioperative and nonoperative settings. Methods We performed an online survey using cases from the Optical Coherence Tomographic Imaging of Thrombus (OPTIMUS) Study, which investigated the prevalence of a culprit lesion thrombus based on intracoronary optical coherence tomography (OCT) in patients experiencing MI. Four MI cases, 2 perioperative and 2 nonoperative, were selected randomly, stratified by etiology. Physicians were provided with the patient’s medical history, laboratory parameters, and electrocardiograms. Physicians did not have access to intracoronary OCT results. The primary outcome was the accuracy of physicians' judgement of MI etiology, measured as raw agreement between physicians and intracoronary OCT findings. Fleiss’ kappa and Gwet’s AC1 were calculated to correct for chance. Results The response rate was 57% (308 of 536). Respondents were 62% male; median age was 45 years (standard deviation ± 11); 45% had been in practice for > 15 years. Respondents’ overall accuracy for MI etiology was 60% (95% confidence interval [CI] 57%-63%), including 63% (95% CI 60%-68%) for nonoperative cases, and 56% (95% CI 52%-60%) for perioperative cases. Overall chance-corrected agreement was poor (kappa = 0.05), consistent across specialties and clinical scenarios. Conclusions Physician accuracy in determining MI etiology based on clinical information is poor. Physicians should consider results from other testing, such as invasive coronary angiography, when determining MI etiology. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020 |
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2021-01-14T04:10:48Z |
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CJC open. New York. Vol. 2, no. 6 (2020), p. 577-584 |
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