Primary Care (incident)

In the Clinical Practice Research Datalink (CPRD, primary care data) we ascertained myocardial infarction (MI) cases by searching for Read terms related to MI diagnosis OR ST elevation MI (STEMI), OR non-ST elevation MI (NSTEMI).

Secondary Care (incident and prevalent)

In Hospital Episode Statistics (HES, secondary care data) we used primary diagnosis of ICD-10 codes (see below) for MI diagnosis, OR ST elevation MI (STEMI), OR non-ST elevation MI, OR procedural codes (OPCS 4) of transluminal coronary thrombolysis.

Diagnoses

Thrombolytic treatment

In the Office for National Statistics (ONS) mortality register, we used ICD-10 and ICD-9 terms to identify fatal MI cases where an MI diagnosis was recorded as the underlying cause of death.

Combining evidence across sources to define and date phenotypes

• Case note review
• EHR Sources
• Prognosis
• Genetic
• Cross-country

For primary care or hospital discharge patients with an associated record in the disease registry (MINAP), the positive predictive value of the acute myocardial infarction diagnosis (the probability that the diagnosis recorded in the disease registry was myocardial infarction rather than unstable angina or a non-cardiac diagnosis) was 92.2% (6660/7224, 95% confidence interval 91.6% to 92.8%) in primary care and 91.5% (6851/7489, 90.8% to 92.1%) in hospital care. Eighty five per cent of patients recorded in primary care and hospital discharge (7386/8707) had a record of raised cardiac markers and half (3766/8707) had a record of ST segment elevation on electrocardiography.

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