Table 5.
Element Name | Element Definition |
---|---|
Pacemaker implantation | If a pacemaker was placed during this
admission, indicate what type of device:
|
Temporary pacemaker ICD | Temporary pacemaker placed during this admission |
An ICD may be placed for:
| |
The brand, model number, and serial number of the device may be recorded. | |
Noninvasive stress testing | Indicate if the patient underwent exercise or pharmacological stress testing with or without echocardiographic or radionuclide imaging. |
Date of noninvasive stress testing | Indicate the date of exercise or pharmacological stress testing with or without echocardiographic or radionuclide imaging. |
Noninvasive angiogram | Indicate if the patient underwent 1 of the
following:
|
Maximum stenosis by vessel (LAD, LCx, RCA, LM, graft) | Stenosis represents the percentage occlusion,
from 0% to 100%, associated with the identified vessel
systems. Percent stenosis at its maximal point is estimated to be the
amount of reduction in the diameter of the “normal”
vessel proximal to the lesion. For the denominator, take the maximum
internal lumen diameter proximal and distal to the lesion. In instances
where multiple lesions are present, enter the highest percentage
stenosis noted. The systems of interest are as follows and should
include major branch vessels of >2 mm diameter:
|
Maximal or submaximal stress test | Maximal stress test (symptom limited) or submaximal test (e.g., modified Bruce protocol ending with stage 1 or stage 2) |
Ischemia result (positive, negative, equivocal, nondiagnostic test) |
|
LVEF assessed | Indicate whether the patient had LVEF assessed via invasive (i.e., LV gram) or noninvasive (i.e., echo, MR, CT or nuclear) testing before or during the admission. |
Resting LV systolic function: global function—ejection fraction | Indicate the ejection fraction category.
Choose 1 of the following:
|
Note: If no diagnostic report is in the medical record, a value documented in the medical record is acceptable. | |
Diagnostic coronary angiography | Indicate if the patient had diagnostic coronary angiography. This is defined as the passage of a catheter into the aortic root or other great vessels for angiography of the native coronary arteries or bypass grafts supplying native coronary arteries. This element would NOT include noninvasive CT angiography. |
Diagnostic coronary angiography date/time Culprit artery | Indicate the date and time the patient had diagnostic coronary angiography, defined as the passage of a catheter into the aortic root or other great vessels. |
This is the vessel considered to be
responsible for the ACS. The investigator should use his or her judgment
in choosing the primary vessel. In cases in which this is difficult to
determine (despite correlation of electrocardiographic changes and
angiographic data), the vessel supplying the largest territory of
myocardium should be selected:
| |
Note: “None” should be considered if there is no apparent coronary vessel lesion that could be responsible for evidence of ischemia. | |
Culprit artery TIMI flow | TIMI grade flow in the culprit artery is
defined as follows:
|
LM stenosis percent | The best estimate of the most severe percent
stenosis in the LM coronary artery. This does not include collaterals.
Indicate the following:
|
Stenosis: Stenosis represents the percent diameter reduction, from 0 to 100, associated with the identified vessel systems. Percent stenosis at its maximal point is estimated to be the amount of reduction in the diameter of the “normal” reference vessel proximal to the lesion. In instances where multiple lesions are present, enter the single highest percent stenosis noted. | |
Note: If the patient only has a PCI (without a diagnostic catheterization at the same sitting), it is acceptable to use prior and recent catheterization lab visit information, even if at another institution. | |
Proximal LAD and first diagonal branches percent stenosis | Indicate the best estimate of the most severe
percent stenosis in the proximal LAD and first diagonal coronary artery
branches of ≥ 2.0 mm in diameter as determined by angiography.
This does not include collateral circulation. Indicate the following:
|
Stenosis: Stenosis represents the percent diameter reduction, from 0 to 100, associated with the identified vessel systems. Percent stenosis at its maximal point is estimated to be the amount of reduction in the diameter of the “normal” reference vessel proximal to the lesion. In instances where multiple lesions are present, enter the single highest percent stenosis noted. | |
Note: If the patient only has a PCI (without a diagnostic catheterization at the same sitting), it is acceptable to use prior and recent catheterization lab visit information, even if at another institution. | |
Mid/distal LAD, D2, and D3 percent stenosis | Indicate the best estimate of the most severe
percent stenosis in the mid/distal LAD and diagonal coronary artery
branches after the first diagonal of ≥2.0 mm in diameter as
determined by angiography. This does not include collateral circulation.
Indicate the following:
|
Stenosis: Stenosis represents the percent diameter reduction, from 0 to 100, associated with the identified vessel systems. Percent stenosis at its maximal point is estimated to be the amount of reduction in the diameter of the “normal” reference vessel proximal to the lesion. In instances where multiple lesions are present, enter the single highest percent stenosis noted. | |
If the patient only has a PCI (without a diagnostic catheterization at the same sitting), it is acceptable to use prior and recent catheterization lab visit information, even if at another institution. | |
Circ, OMs, LPDA, and LPL branches percent stenosis | Indicate the best estimate of the most severe
percent stenosis in the Circ, OMs, LPDA, and LPL coronary artery
branches of ≥2.0 mm in diameter as determined by angiography.
This does not include collaterals. Indicate the following:
|
Stenosis: Stenosis represents the percent diameter reduction, from 0 to 100, associated with the identified vessel systems. Percent stenosis at its maximal point is estimated to be the amount of reduction in the diameter of the “normal” reference vessel proximal to the lesion. In instances where multiple lesions are present, enter the single highest percent stenosis noted. | |
If the patient only has a PCI (without a diagnostic catheterization at the same sitting), it is acceptable to use prior and recent catheterization lab visit information, even if at another institution. | |
RCA, PDA, RPL, and AM branches percent stenosis | Indicate the best estimate of the most severe
percent stenosis in the RCA, PDA, RPL, and AM branches of ≥2.0
mm in diameter as determined by angiography. This does not include
collaterals. Indicate the following:
|
Stenosis: Stenosis represents the percent diameter reduction, from 0 to 100, associated with the identified vessel systems. Percent stenosis at its maximal point is estimated to be the amount of reduction in the diameter of the “normal” reference vessel proximal to the lesion. In instances where multiple lesions are present, enter the single highest percent stenosis noted. | |
If the patient only has a PCI (without a diagnostic catheterization at the same sitting), it is acceptable to use prior and recent catheterization lab visit information, even if at another institution. | |
Ramus percent stenosis | Indicate the best estimate of the most severe
percent stenosis in the ramus artery (if present) of ≥2.0 mm in
diameter as determined by angiography. This does not include
collaterals. Indicate the following:
|
Stenosis: Stenosis represents the percent diameter reduction, from 0 to 100, associated with the identified vessel systems. Percent stenosis at its maximal point is estimated to be the amount of reduction in the diameter of the “normal” reference vessel proximal to the lesion. In instances where multiple lesions are present, enter the single highest percent stenosis noted. | |
If the patient only has a PCI (without a diagnostic catheterization at the same sitting), it is acceptable to use prior and recent catheterization lab visit information, even if at another institution. | |
Catheterization contraindication | Indicate if catheterization was not performed. Contraindications may include patient refusal, advanced age, patient not a candidate for revascularization, DNR order, active bleeding, and clinical contraindications/severe comorbidities. |
Reperfusion Therapy | |
Reperfusion therapy: reperfusion candidate | Indicate if the patient is a candidate for
reperfusion therapy for treatment of STEMI. Reperfusion therapy includes
thrombolysis and primary PCI. Choose 1 of the following:
|
Reperfusion therapy: type of reperfusion | If the patient received reperfusion therapy,
indicate the type of reperfusion. Choose all that apply:
|
| |
PCI | |
PCI | Indicate if the patient underwent PCI, placement of an angioplasty guidewire, balloon, or other device (e.g., stent, atherectomy, brachytherapy, or thrombectomy catheter) into a native coronary artery or CABG for the purpose of mechanical coronary revascularization. |
Catheterization lab arrival date/time | Indicate the date and time the patient arrived at the catheterization lab where the PCI was being performed as documented in the medical record. |
First device activation date/time | Indicate the date and time the first device
was activated regardless of the type of device used. Use the earliest
time from the following:
|
Please note that this is a process measure about the timeliness of treatment. It is NOT a clinical outcomes measure based on TIMI flow or clinical reperfusion. It does not matter whether the baseline angiogram showed TIMI 3 flow or if the final post- PCI angiogram showed TIMI 0 flow. What is being measured is the time of the first mechanical treatment of the culprit lesion, not the time when TIMI 3 flow was (or was not) restored. | |
PCI indication | Indicate the primary reason PCI was performed
or attempted. Choose 1 of the following:
|
Nonsystem reason for delay in PCI | Indicate if there is documentation of a reason
for a delay in doing the first PCI after hospital arrival by a
physician/advanced practice nurse/physician assistant. System reasons
for delay are NOT acceptable.
|
Stent placed | Indicate if a stent was placed in the affected coronary artery. |
Stent type | Indicate the type of stent if a stent was placed in the affected coronary artery. |
Choose all that apply:
| |
Number of stents placed | Number of stents placed. The exact type of stent should be collected. |
| |
Thrombolytics | |
Thrombolytics type | If the patient received reperfusion therapy
with thrombolytics, indicate the type of thrombolytics used. Choose 1 of
the following:
|
Thrombolytics dose | If the patient received reperfusion therapy
with thrombolytics, indicate the strength of dose of the thrombolytics.
Choose 1 of the following:
|
Thrombolytics start date/time | If the patient received reperfusion therapy with thrombolytics, indicate the time of either the first bolus or the beginning of the infusion. |
Note: If the facility receives a transfer patient with ongoing infusion, record the time that the infusion was started at the transferring facility. | |
Nonsystem reason for delay of thrombolytics | Indicate if there is documentation of a nonsystem reason for delay in initiating thrombolytic therapy >30 min from the time of first facility arrival (including an ambulance capable of administering thrombolytic therapy). |
Note: A patient being transferred into a facility is not considered a nonsystem reason for delay. | |
| |
Contraindications for reperfusion therapy | |
Contraindication to PCI | Indicate why PCI was not performed as
reperfusion therapy. Choose 1 of the following:
|
Contraindication to thrombolytics | Indicate why thrombolytics were not
administered as reperfusion therapy. Choose 1 of the following:
|
Other Invasive Therapeutic Interventions | |
CABG surgery | Indicate if the patient underwent CABG surgery during this admission. |
CABG surgery date/time | Indicate the date and time the patient entered the operating room suite or the first time surgery was documented on the operating room report. |
IABP | Indicate if IABP was used during this admission. |
Circulatory support | Indicate if circulatory support was provided
during this admission and which type:
|
Pulmonary artery catheter | Indicate if a pulmonary artery (Swan Ganz) catheter was used during this admission. |
Ventilator | Indicate the need for intubation and respiratory support on a ventilator. Include the date and time the patient was put on and taken off the ventilator. |
ACS indicates acute coronary syndrome; AM, acute marginal; AV, arteriovenous; BiVAD, biventricular assist device; CABG, coronary artery bypass graft; Circ, circumflex; CPR, cardiopulmonary resuscitation; CRT, cardiac resynchronization therapy; CRT-D, cardiac resynchronization therapy defibrillator; CRT-P, cardiac resynchronization therapy pacemaker; CT, computed tomography; D2 diagonal branch 2; D3 diagonal branch 3; DNR, do not resuscitate; ECG, electrocardiogram; ECMO, extracorporeal membrane oxygenation; IABP, intraortic balloon pump; ICD, implantable cardioverter-defibrillator; IV, intravenous; LAD, left anterior descending; LBBB, left bundle-branch block; LCx, left circumflex; LM, left main; LPDA, left posterior descending artery; LPL left posterolateral; LV, left ventricle; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; MR, magnetic resonance; NSTEMI, non-ST-segment elevation myocardial infarction; OM, obtuse marginal; PCI, percutaneous coronary intervention; PDA, posterior descending artery; RCA, right coronary artery; RPL, right posterolateral; STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombolysis in Myocardial Infarction; VF, ventricular fibrillation; and VT, ventricular tachycardia.