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1 Supplementary Online Content Guimarães PO, Krishnamoorthy A, Kaltenbach LA, et al. Accuracy of medical claims for identifying cardiovascular and bleeding events after myocardial infarction: a secondary analysis of the TRANSLATE-ACS study. JAMA Cardiol. Published online May 24, doi: /jamacardio etable 1. Clinical Event Definitions etable 2. Medical Billing Codes Used for Recurrent Events etable 3. Cumulative Incidence of Events Within 1 Year Using Medical Claims Identified and Physician-Adjudicated Events After Excluding Patients With Rehospitalizations Missing ICD-9-CM Codes etable 4. Event Rates for MI and Bleeding, as Well as the Composite of Death, MI, and Stroke Within 1 Year Among Female and Male Patients This supplementary material has been provided by the authors to give readers additional information about their work.
2 etable 1. Clinical Event Definitions Event MI Definition A diagnosis of NSTEMI or STEMI on a hospitalization report, typically defined as ischemic symptoms, and one of the following: a. Cardiac biomarkers with at least one of the values in the abnormal range for that laboratory (typically above the 99 th percentile of the upper reference limit for normal patients) b. ECG changes indicative of new ischemia (new ST-T changes, new left bundle branch block, development of pathological Q-waves [or equivalent findings for true posterior MI]) c. Imaging evidence (e.g., echocardiographic, nuclear) of new loss of viable myocardium or new regional wall motion abnormality Stroke A diagnosis of stroke or cerebrovascular accident on the hospitalization report, typically defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms at least 24 hours after onset or leading to death. GUSTO bleeding Non CABG-related GUSTO severe or life-threatening bleeding was any intracranial hemorrhage or any bleeding event resulting in substantial hemodynamic compromise requiring treatment. Non CABG-related GUSTO moderate bleeding was any bleeding event resulting in the need for transfusion that was not considered a GUSTO severe or life-threatening bleed. Non CABG-related GUSTO mild bleeding was any other bleeding event that does not require transfusion or cause hemodynamic compromise. Abbreviations: CABG, coronary artery bypass grafting; GUSTO, Global Utilization of t-pa and Streptokinase for Occluded Coronary Arteries; MI, myocardial infarction; NSTEMI, non STsegment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction
3 etable 2. Medical Billing Codes Used for Recurrent Events Event MI Stroke Medical billing code 410.x1 (acute MI initial episode of care) 430 (subarachnoid hemorrhage), 431 (intracerebral hemorrhage), 433.x1 (occlusion and stenosis of precerebral arteries with cerebral infarction), 434.x1 (occlusion of cerebral arteries with cerebral infarction), or (iatrogenic cerebrovascular infarction or hemorrhage) Bleeding (internal hemorrhoids with other complication), (external hemorrhoids with other complication), (unspecified hemorrhoids with other complication), (esophageal varices with bleeding), (esophageal varices in disease classified elsewhere with bleeding), (ulcer of esophagus with bleeding), (gastroesophageal lacerationhemorrhage syndrome [Mallory-Weiss syndrome]), (esophageal hemorrhage), 531.0x (acute gastric ulcer with hemorrhage), 531.2x (acute gastric ulcer with hemorrhage and perforation), 531.4x (chronic or unspecified gastric ulcer with hemorrhage), 531.6x (chronic or unspecified gastric ulcer with hemorrhage and perforation), 532.0x (acute duodenal ulcer with hemorrhage), 532.2x (acute duodenal ulcer with hemorrhage and perforation), 532.4x (chronic or unspecified duodenal ulcer with hemorrhage), 532.6x (chronic or unspecified duodenal ulcer with hemorrhage and perforation), 533.0x (acute peptic ulcer with hemorrhage), 533.2x (acute peptic ulcer with hemorrhage and perforation), 533.4x (chronic or unspecified peptic ulcer with hemorrhage), 533.6x (chronic or unspecified peptic ulcer with hemorrhage and perforation), 534.0x (acute gastrojejunal ulcer with hemorrhage), 534.2x (acute gastrojejunal ulcer with hemorrhage and perforation), 534.4x (chronic or unspecified gastrojejunal ulcer with hemorrhage), 534.6x (chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation), 535.x1 (gastritis and duodenitis), (angiodysplasia of stomach and duodenum with hemorrhage), (diverticulosis of colon with hemorrhage), (diverticulitis of colon with hemorrhage), (diverticulosis of small intestine with hemorrhage), (diverticulitis of small intestine with hemorrhage), (Dieulafoy lesion [hemorrhagic] of intestine), (hematemesis), (blood in stool), (hemorrhage of gastrointestinal tract unspecified), 430 (subarachnoid hemorrhage), 431 (intracerebral hemorrhage), (nontraumatic extradural hemorrhage), (subdural hemorrhage), (unspecified intracranial hemorrhage), (hemorrhage into bladder wall), (hematuria), (other specified noninflammatory disorders of vagina [cyst of vagina; hemorrhage of vagina]), (excessive or frequent menstruation), (metrorrhagia [bleeding unrelated to
4 menstrual cycle; irregular intermenstrual bleeding]), (other (dysfunctional or functional uterine hemorrhage), (retinal hemorrhage), (hemopericardium), (hemoperitoneum), (hemarthrosis), (epistaxis), (hemorrhage from throat), (hemoptysis), (acute posthemorrhagic anemia [anemia due to acute blood loss]), or (hemorrhage, unspecified). Transfusion codes 999.6, 999.7, (transfusion reaction), (transfusion-related lung injury), 99.0x (transfusion) Abbreviations: MI, myocardial infarction
5 etable 3. Cumulative Incidence of Events Within 1 Year Using Medical Claims Identified and Physician-Adjudicated Events After Excluding Patients With Rehospitalizations Missing ICD-9- CM Codes Cumulative incidence within 1 year (%) MI Stroke Bleeding All patients (n=12,351) Medical claims Physician-adjudicated Excluding patients with 2 or more rehospitalizations missing ICD-9-CM codes (n=12,130) Medical claims Physician-adjudicated Excluding patients with any rehospitalizations missing ICD-9-CM codes (n=11,589) Medical claims Physician-adjudicated Abbreviations: ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification (code)
6 etable 4. Event Rates for MI and Bleeding, as Well as the Composite of Death, MI, and Stroke Within 1 Year Among Female and Male Patients MI Cumulative Incidence (%) HR (95% CI) * Female Male Physician-adjudicated (1.22, 1.67) Medical claims 1 st diagnosis code (1.05, 1.59) Medical claims 1 st or 2 nd diagnosis code (1.09, 1.52) Medical claims all diagnosis codes (1.16, 1.64) Bleeding Physician-adjudicated (1.37, 1.82) Medical claims 1 st diagnosis code (1.35, 2.13) Medical claims 1 st or 2 nd diagnosis code (1.33, 2.00) Medical claims all diagnosis codes (1.32, 1.82) Death, MI, stroke Physician-adjudicated (1.18, 1.53) Medical claims 1 st diagnosis code (1.14, 1.54) Medical claims 1 st or 2 nd diagnosis code (1.16, 1.53) Medical claims all diagnosis codes (1.20, 1.59) Abbreviations: CI, confidence interval; HR, hazard ratio; MI, myocardial infarction * Male as the reference group
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