In this secondary analysis of a clinical trial of 12 365 patients with acute myocardial infarction, the cumulative 1-year event rates for myocardial infarction, stroke, and bleeding were lower when medical claims were used to identify events compared with physician adjudication. Billed diagnoses were modestly accurate in identifying myocardial infarction and stroke admissions but had limited accuracy in identifying bleeding events.

Event rates at 1 year were lower for MI, stroke, and bleeding when medical claims were used rather than physician adjudication. Moderate agreement between medical claims and physician adjudication was observed in ascertaining MI and stroke events, but agreement was worse for bleeding events. While medical claims may be a reasonable resource to assess MI and stroke outcomes, caution is still needed. Medical claims have limited accuracy in identifying bleeding events, which suggests the need for an alternative approach to ensure good safety surveillance in cardiovascular studies.

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