Validity of myocardial infarction diagnoses in administrative databases: a systematic review

PLoS One. 2014 Mar 28;9(3):e92286. doi: 10.1371/journal.pone.0092286. eCollection 2014.


Background: Though administrative databases are increasingly being used for research related to myocardial infarction (MI), the validity of MI diagnoses in these databases has never been synthesized on a large scale.

Objective: To conduct the first systematic review of studies reporting on the validity of diagnostic codes for identifying MI in administrative data.

Methods: MEDLINE and EMBASE were searched (inception to November 2010) for studies: (a) Using administrative data to identify MI; or (b) Evaluating the validity of MI codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value (PPV), negative predictive value, or Kappa scores) for MI, or data sufficient for their calculation. Additonal articles were located by handsearch (up to February 2011) of original papers. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.

Results: Thirty studies published from 1984-2010 were included; most assessed codes from the International Classification of Diseases (ICD)-9th revision. Sensitivity and specificity of hospitalization data for identifying MI in most [≥50%] studies was ≥86%, and PPV in most studies was ≥93%. The PPV was higher in the more-recent studies, and lower when criteria that do not incorporate cardiac troponin levels (such as the MONICA) were employed as the gold standard. MI as a cause-of-death on death certificates also demonstrated lower accuracy, with maximum PPV of 60% (for definite MI).

Conclusions: Hospitalization data has higher validity and hence can be used to identify MI, but the accuracy of MI as a cause-of-death on death certificates is suboptimal, and more studies are needed on the validity of ICD-10 codes. When using administrative data for research purposes, authors should recognize these factors and avoid using vital statistics data if hospitalization data is not available to confirm deaths from MI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Clinical Coding / statistics & numerical data*
  • Databases, Factual / statistics & numerical data*
  • Death Certificates
  • Hospitalization / statistics & numerical data
  • Humans
  • International Classification of Diseases / statistics & numerical data*
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Sensitivity and Specificity
  • Young Adult

Grants and funding

This study was funded in part by the Canadian Arthritis Network ( JAAZ held a salary award from the Canadian Arthritis Network and The Arthritis Society of Canada. He is currently the British Columbia Lupus Society Scholar. DL holds the Mary Pack Chair in Arthritis Research from UBC and The Arthritis Society of Canada. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.