Key result
Clinical assessment identifies MI etiology with only ~60% accuracy compared to intracoronary OCT.
Why the study?
Little is known about the accuracy of physicians' clinical judgement in differentiating type 1 from type 2 myocardial infarction based on clinical information in perioperative and nonoperative settings.
Does clinical judgement accurately differentiate type 1 and type 2 myocardial infarction compared to intracoronary OCT?
Cross-Sectional (n=308)
Physicians blinded to cardiac angiography and OCT results
Yes
Does clinical judgement accurately differentiate type 1 and type 2 myocardial infarction compared to intracoronary OCT?
Effect estimate: 60% accuracy (95% CI 57%-63%)
Physicians have poor accuracy in differentiating type 1 from type 2 MI based solely on clinical information, highlighting the need for invasive or advanced imaging assessments.
Clinical judgment of MI etiology warrants caution and should not yet change practice; leaves open need for prospective OCT validation studies.
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: (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 et al. (2020) conducted a cross-sectional in Myocardial Infarction (Type 1 vs Type 2 differentiation) (n=308). Clinical judgement based on medical history, laboratory parameters, and electrocardiograms vs. Intracoronary optical coherence tomography (OCT) findings was evaluated on Accuracy of physicians' judgement of MI etiology (type 1 vs type 2) (60% accuracy, 95% CI 57%-63%). Physician accuracy in determining MI etiology based on clinical information was poor, with an overall accuracy of 60% compared to intracoronary OCT findings.
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