Declining Autopsy Rates and Diagnosis of Myocardial Infarction-Reply

Abstract

In Reply.— In regard to Lawrence K. Altman's interesting speculation and question, we have not done the alternative study, namely, to determine how frequently the diagnosis of myocardial infarction is made but not confirmed by autopsy. In autopsied cases, records can be retrieved only by use of the corrected diagnosis as established by the autopsy; the determination of antemortem diagnoses would require a careful study of the records of all patients whose autopsy diagnosis was not acute myocardial infarction—a much more time-consuming process than the published study and one that has not been done. It is purely impression, but we suspect that the number of incorrect diagnoses of acute myocardial infarction would certainly equal the number of cases in which actual myocardial infarction was missed; hence, the two errors could counterbalance one another and the changing autopsy percentages could be expected to have little effect on changing rates of cardiovascular