Myocardial Infarction phenotype
Name phenotype_mi
Chapter Circulatory disease/Myocardial infarction
Definition
Fatal or non-fatal myocardial infarction (MI) as recorded in any of the constituent CALIBER data sources. The type of myocardial infarction (ST elevation MI, STEMI; or non ST elevation MI, NSTEMI) is recorded only in MINAP and GPRD. 

If there are records of non-ST elevation MI and ST elevation MI on the same date, the more severe diagnosis (STEMI) is taken as correct. If there is a record of unspecified MI and STEMI / NSTEMI on the same date, the non-specific diagnosis is ignored.

MI may be recorded multiple times in the different datasets with slightly different dates. It is up to the researcher to decide what time interval should be used as a cut-off for considering that two events close to each other are distinct events rather than multuiple records of the same event; we would suggest 7 days because this is just greater than the usual duration of hospitalization for myocardial infarction.

The set of codes included in the GPRD definition were guided by the validation study, reference: 
Herrett E, Shah AD, Boggon R, Denaxas S, Smeeth L, van Staa T, Timmis A, Hemingway H. Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study. BMJ. 2013 May 20;346:f2350. doi: 10.1136/bmj.f2350.
Data sources GPRD, HES, MINAP, ONS
Dictionaries Read, OPCS 4, ICD 10, ICD 9
Repeated Yes
Agreed 23/11/2012 (Revision 1)
Implementation
STEMI is defined by a record of any of the following in CALIBER:
1. Primary care diagnosis of MI: myo_infarct_gprd, category 3
2. Secondary care diagnosis of MI: myo_infarct_hes, category 3
3. MINAP disease registry diagnosis of STEMI (taking into account discharge diagnosis, ECG findings and cardiac markers - see flowchart)
4. Secondary care procedure code for coronary thrombolysis: lysis_opcs category 2

NSTEMI is defined by a record of any of the following in CALIBER:
1. Primary care diagnosis of MI: myo_infarct_gprd, category 4
2. Secondary care diagnosis of MI: myo_infarct_hes, category 4
3. MINAP disease registry diagnosis of NSTEMI (taking into account discharge diagnosis, ECG findings and cardiac markers - see flowchart)
AND 
no STEMI record on the same date

Acute MI not further specified is defined by a record of any of the following in CALIBER:
1. Primary care diagnosis of MI: myo_infarct_gprd, category 5
2. Secondary care diagnosis of MI: myo_infarct_hes, category 5
3. Death with primary cause MI: mi_ons, category 3
4. Death prior to 2001 with primary cause MI: mi_onsicd9, category 3
AND 
no STEMI or NSTEMI record on the same date
Phenotype components
Variable TitleCategories
myo_infarct_gprd Myocardial infarction and complications (primary care)
  • 3 - STEMI
  • 4 - NSTEMI
  • 5 - Acute MI not further specified
myo_infarct_hes Myocardial infarction and complications (secondary care)
  • 5 - Acute MI not further specified
mi_minap Acute myocardial infarction admission (disease registry)
  • 1 - Acute STEMI
  • 2 - Acute NSTEMI
lysis_opcs Coronary thrombolysis procedure (secondary care)
  • 2 - Transluminal coronary thrombolysis
mi_ons Myocardial infarction mortality
  • 3 - Death from MI
mi_onsicd9 Myocardial infarction mortality (prior to 2000)
  • 3 - Death from myocardial infarction
Codelist version
Codelist authors
Creation date
Warning! Unless explicitly noted otherwise, three-digit ICD10/OPCS4 codes also include all codes below them.
Category (code) Read code Read term CPRD Medcode
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