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Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In-Hospital Mortality Rates


Address correspondence to Amy Metcalfe, M.Sc., Departments of Community Health Sciences and Clinical Neurosciences, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; e-mail:



To identify validated ICD-9-CM/ICD-10 coded case definitions for acute myocardial infarction (AMI).

Data Sources

Ovid Medline (1950–2010) was searched to identify studies that validated acute myocardial infarction (AMI) case definitions. Hospital discharge abstract data and chart data were linked to validate identified AMI definitions.

Study Design

Systematic literature review, chart review, and administrative data analysis.

Data Collection/Extraction Methods

Data on sensitivity/specificity/positive and negative predictive values (PPV and NPV) were extracted from previous studies to identify validated case definitions for AMI. These case definitions were validated in administrative data through chart review and applied to hospital discharge data to assess in-hospital mortality.

Principal Findings

Of the eight ICD-9-CM definitions validated in the literature, use of ICD-9-CM code 410 to define AMI had the highest sensitivity (94 percent) and specificity (99 percent). In our data, ICD-9-CM/ICD-10 codes 410/I21-I22 in all available coding fields had high sensitivity (83.3 percent/82.8 percent) and PPV (82.8 percent/82.2 percent). The in-hospital mortality among AMI patients identified using this case definition was 7.6 percent in ICD-9-CM data and 6.6 percent in ICD-10 data.


We recommend that ICD-9-CM 410 or ICD-10 I21-I22 in the primary diagnosis coding field should be used to define AMI. The use of a consistent validated case definition would improve comparability across studies