From the Guidelines
Yes, acute myocardial infarction (AMI) can be used as the cause of death on a death certificate. AMI represents a specific pathological event where blood flow to the heart muscle is suddenly blocked, causing tissue damage and potentially fatal consequences. When completing a death certificate, physicians should identify the most specific and immediate cause of death possible, and AMI meets these criteria as it describes a definitive pathological process [ 1 ]. The certificate typically follows a causal sequence, where AMI might be listed as the immediate cause, with underlying conditions like coronary artery disease or atherosclerosis listed as antecedent causes.
For proper documentation, the physician should specify the type of AMI (STEMI or NSTEMI if known), the approximate time between onset and death, and any relevant complications like cardiogenic shock or ventricular rupture. This specificity helps create accurate mortality statistics and provides valuable information for public health surveillance and research on cardiovascular disease prevention and treatment. According to the 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials, death by any cardiovascular mechanism within 30 days after an acute MI should be considered a death due to MI [ 1 ].
Key considerations for attributing death to AMI include:
- Verification of acute MI by diagnostic criteria or autopsy findings [ 1 ]
- Attribution of death to MI if it occurs within 30 days of the event [ 1 ]
- Consideration of complications or procedures related to the MI as part of the causal sequence [ 1 ]
- Importance of accurate and specific documentation for public health and research purposes [ 1 ]
From the Research
Acute Myocardial Infarction as Cause of Death
- Acute myocardial infarction (AMI) can be used as the cause of death, but the accuracy of death certificates in reporting this information is a concern 2.
- Studies have shown that death certificates may miss AMI as the underlying cause of death in a significant number of cases, with errors of omission ranging from 25% to 48% 2.
- Conversely, death certificates may also erroneously assert the presence of an AMI, highlighting the need for accurate diagnosis and reporting 2.
Diagnosis and Treatment of AMI
- The diagnosis and treatment of AMI involve a range of interventions, including oxygen, sublingual nitroglycerin, morphine, aspirin, heparin, and intravenous nitroglycerin 3.
- Early mechanical or pharmacological reperfusion should be performed for patients with AMI within 12 hours of symptom onset 4.
- Adjunctive therapy with antiplatelets and antithrombotics is essential in the management of AMI 4.
Prehospital Administration of Aspirin and Nitroglycerin
- Prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals may be beneficial for patients with suspected ACS, although the certainty of evidence is very low 5.
- Studies have shown that prehospital administration of aspirin and nitroglycerin is associated with significantly lower 30-day and 1-year mortality compared to administration after arrival at hospital 5.
General Pharmacologic Treatment of AMI
- The general pharmacotherapeutic issues surrounding AMI are complex and expanding, with basic therapy including oxygen, nitroglycerin, aspirin, and morphine 6.
- Cardioprotective agents, such as beta-adrenergic antagonists, should be considered early in the treatment of AMI 6.
- Heparin and GP IIb/IIIa inhibitors also have well-established roles in the treatment of acute coronary syndromes 6.