title: Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
abstract: We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26%) were definite/probable MIs. Almost as many secondary (48%) as primary (52%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78% had elevated troponin concentrations (positive predictive value = 57%, 95% confidence interval: 52, 62); however, only 44% had clinical diagnoses of MI (positive predictive value = 45%, 95% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.
authors.forename: H M
authors.initials: HM
authors.lastname: Crane
authors.forename: S R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: D R
authors.initials: DR
authors.lastname: Drozd
authors.forename: M J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: J A C
authors.initials: JA
authors.lastname: Delaney
authors.forename: C
authors.initials: C
authors.lastname: Rodriguez
authors.forename: P
authors.initials: P
authors.lastname: Paramsothy
authors.forename: W B
authors.initials: WB
authors.lastname: Lober
authors.forename: G
authors.initials: G
authors.lastname: Burkholder
authors.forename: J H
authors.initials: JH
authors.lastname: Willig
authors.forename: M J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: W C
authors.initials: WC
authors.lastname: Mathews
authors.forename: P K
authors.initials: PK
authors.lastname: Crane
authors.forename: R D
authors.initials: RD
authors.lastname: Moore
authors.forename: S
authors.initials: S
authors.lastname: Napravnik
authors.forename: J J
authors.initials: JJ
authors.lastname: Eron
authors.forename: P
authors.initials: P
authors.lastname: Hunt
authors.forename: E
authors.initials: E
authors.lastname: Geng
authors.forename: P
authors.initials: P
authors.lastname: Hsue
authors.forename: G S
authors.initials: GS
authors.lastname: Barnes
authors.forename: J
authors.initials: J
authors.lastname: McReynolds
authors.forename: I
authors.initials: I
authors.lastname: Peter
authors.forename: C
authors.initials: C
authors.lastname: Grunfeld
authors.forename: M S
authors.initials: MS
authors.lastname: Saag
authors.forename: M M
authors.initials: MM
authors.lastname: Kitahata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003661:Decision Support Techniques; D015340:Epidemiologic Research Design; D005189:False Positive Reactions; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
keywords: HIV; myocardial infarction; validation