Discharge diagnosis
Name F_diag
Chapter MINAP/Discharge
The biochemical "definition" of infarction remains imprecise because of the variations in assay performance. Until a Standardised assay becomes available it is recommended that these definitions are used.
Data Type Categorical
Data sources MINAP
Repeated No
Valid event date range 01/01/2003 - 08/06/2009
Agreed 01/12/2010 (Revision 9.1)
Category DefinitionNotes
1 Myocardial infarction (ST elevation) There will normally be a history consistent with the diagnosis. The diagnosis requires the presence of cardiographic changes of ST elevation consistent with infarction of =>2mm in contiguous chest leads and/or ST elevation of =>1mm ST elevation in 2 or more standard leads. (New LBBB is included; although ST elevation is usually apparent in the presence of LBBB). There must be enzyme or troponin elevation. Where CK is used the peak value should exceed twice the upper limit of the reference range. Where tropopin assay is used the locally accepted cut off value should be used. (See Threatened MI) This group includes all patients with STEMI regardless of whether typical changes were evident on the admission ECG or developed subsequently.
3 Threatened MI After early reperfusion treatment there may be rapid resolution of existing ST elevation associated with a CK rise less than twice the upper limit of normal or a small troponin release. If only troponin has been measured and is elevated; it is a local decision whether this is recorded as "Definite infarction" or "Threatened infraction".
4 Acute coronary syndrome (troponin positive)/nSTEMI ACS troponin positive includes all those patients previously defined as nSTEMI. There must be symptoms consistent with cardiac ishcaemia and ther will normally be cardiographic changes consistent with this diagnosis. Troponin elevation above locally determined reference level is mandatory.
5 Acute coronary syndrome (troponin negative) Use where there are symptoms consistent with cardiac ischaemia without troponin release. There must be dynamic ECG changes consistent with fluctuating ischaemia. Synonym unstable angina.
6 Chest pain of uncertain cause Use in any patient admitted with chest pain not accompanied by significant cardiographic changes, without any enzyme / troponin release, and where no other clear diagnosis emerges. It is likely that at admission there was a high index of clinical suspicion that the pain was cardiac, but this remains uncorfirmed.
7 Myocardial infarction (unconfirmed) This diagnosis must only be applied to patients who die in hospital before biochemical confirmation of infarction can be confirmed.
8 Other diagnosis Use where a patient is admitted with clinical suspicion of cardiac pain and where any diagnosis other than cardiac ischaemia is confirmed.
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