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Protocol for the China PEACE (Patient-centered Evaluative
Assessment of Cardiac Events) Retrospective Study of
Coronary Catheterization and Percutaneous Coronary
Intervention
Journal: BMJ Open
Manuscript ID: bmjopen-2013-004595
Article Type: Protocol
Date Submitted by the Author: 02-Dec-2013
Complete List of Authors: Li, Jing; Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease Dharmarajan, Kumar; Yale-New Haven Hospital, Center for Outcomes Research and Evaluation; Columbia University Medical Center, Division of Cardiology Li, Xi; Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease Lin, Zhenqiu; Yale-New Haven Hospital, Center for Outcomes Research and Evaluation Normand, Sharon-Lise; Harvard School of Public Health, Division of
Cardiology; Harvard Medical School, Department of Health Care Policy Krumholz, Harlan; Yale-New Haven Hospital, Center for Outcomes Research and Evaluation; Yale University School of Medicine, Department of Internal Medicine Jiang, Lixin; Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease
<b>Primary Subject Heading</b>:
Cardiovascular medicine
Secondary Subject Heading: Epidemiology
Keywords: catheterization, angiography, angioplasty, Epidemiology < TROPICAL MEDICINE, China
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Protocol for the China PEACE (Patient-centered Evaluative Assessment of
Cardiac Events) Retrospective Study of Coronary Catheterization and
Percutaneous Coronary Intervention
Jing Li*, MD, PhDa; Kumar Dharmarajan*, MD, MBAb,c; Xi Li, MD, PhDa; Zhenqiu Lin, PhDb;
Sharon-Lise T. Normand, PhDd,e; Harlan M. Krumholz†, MD, SMb,f,g; Lixin Jiang†, MD, PhDa
(*joint first authors; †joint senior authors); for the China PEACE Collaborative Groupa,b
aState Key Laboratory of Cardiovascular Disease, China Oxford Centre for International Health
Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China;
bCenter for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven,
Connecticut, United States; cDivision of Cardiology, Columbia University Medical Center, New
York, New York, United States; dDepartment of Biostatistics, Harvard School of Public Health,
Boston, Massachusetts, United States; eDepartment of Health Care Policy, Harvard Medical
School, Boston, Massachusetts, United States; fSection of Cardiovascular Medicine and the
Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale
University School of Medicine, New Haven, Connecticut, United States; gDepartment of Health
Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States
Corresponding author. Professor Lixin Jiang, China Oxford Centre for International Health
Research, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, People’s Republic of China; Tel:
+86 10 8839 6203; Fax: +86 10 8836 5201; Email: [email protected]
Keywords. catheterization, angiography, angioplasty, epidemiology, China
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Word count. 3,845 (main manuscript text excluding title page, abstract, acknowledgments,
contributor statement, competing interests statement, funding statement, ethical approval
statement, transparency statement, data sharing statement, references, figures, and tables)
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ABSTRACT
Introduction. During the past decade, the volume of percutaneous coronary intervention (PCI)
in China has risen by more than 20-fold. Yet little is known about patterns of care and outcomes
across hospitals, regions, and time during this period of rising cardiovascular disease and
dynamic change in the Chinese heath care system.
Methods and analysis. Using the China PEACE (Patient-centered Evaluative Assessment of
Cardiac Events) research network, the Retrospective Study of Coronary Catheterization and
Percutaneous Coronary Intervention (China PEACE-Retrospective CathPCI Study) will examine
a nationally representative sample of 11,900 patients who underwent coronary catheterization
or PCI at 55 Chinese hospitals during 2001, 2006, and 2011. We selected patients and study
sites using a 2-stage cluster sampling design with simple random sampling stratified within
economic-geographic strata. A central coordinating center will monitor data quality at the stages
of case ascertainment, medical record abstraction, and data management. We will examine
patient characteristics, diagnostic testing patterns, procedural treatments, and in-hospital
outcomes including death, complications of treatment, and costs of hospitalization. We will
additionally characterize variation in treatments and outcomes by patient characteristics,
hospital, region, and study year.
Ethics and dissemination. The China PEACE collaboration is designed to translate research
into improved care for patients. The study protocol was approved by the central ethics
committee at the China National Center for Cardiovascular Diseases and collaborating
hospitals. Findings will be shared with participating hospitals, policymakers, and the academic
community to promote quality monitoring, quality improvement, and the efficient allocation and
use of both coronary catheterization and PCI in China.
Registration details. www.clinicaltrials.gov (NCT01624896).
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ARTICLE SUMMARY
Article focus
1. Study protocol for a retrospective observational study to examine the characteristics,
treatments, and outcomes of patients who receive diagnostic catheterization and
percutaneous coronary intervention (PCI) in China between 2001 and 2011.
Key messages
1. Although the overall volume of coronary catheterization and PCI procedures performed in
China is known, there are gaps in knowledge about the details of their use and associated
outcomes, including their variation over time and by site of care.
2. China PEACE is a collaborative effort of hospitals, academicians, and policy makers to
generate new knowledge relevant to practice and policy and to translate this knowledge into
action to improve care and outcomes for patients with cardiovascular disease in China.
3. The Retrospective Study of Coronary Catheterization and Percutaneous Coronary
Intervention leverages the China PEACE network to examine a nationally representative
sample of almost 12,000 patients who underwent coronary catheterization or PCI from 55
Chinese hospitals during 2001, 2006, and 2011.
Strengths and limitations of this study.
1. Hospitalizations were sampled from a nationally representative hospital network for the
years 2001, 2006, and 2011 to examine the influence of major changes in the Chinese
health care system and the creation of PCI guidelines by Chinese medical societies.
2. To elevate the quality of abstracted data, the study uses data collection techniques regularly
employed by international clinical trials such as integrated central and on-site monitoring as
well as source document checking.
3. Findings will be shared with hospitals and policy makers to improve health care quality.
4. Patient outcomes are limited to in-hospital outcomes, and data collection is limited to
information available in the medical record.
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INTRODUCTION
China, a country with a rapidly rising prevalence of cardiovascular disease,[1-3] is
concomitantly expanding access to advanced cardiovascular procedures. During the past
decade, the volume of percutaneous coronary intervention (PCI) has increased more than 20-
fold.[4, 5] This expansion has occurred in the context of rising rates of both health insurance
coverage and health care costs.[6, 7] The optimal deployment of advanced care strategies in
settings of constrained resources is a common challenge faced by many low- and middle-
income countries.[8]
Although the overall volume of coronary catheterization and PCI procedures performed
in China is known,[9-12] there are gaps in knowledge about the details of their use and
associated outcomes. Nationally representative data are lacking, and studies have generally
included only a small number of hospitals in circumscribed geographic areas or single time
periods.[5, 13-15] Longitudinal data on coronary catheterization and PCI have largely been
derived from a single center.[16] We therefore know relatively little about patient selection, use
of specific procedural technologies and adjunctive therapies, and patient outcomes, including
their variation over time and by site of care. We know even less about the influence of major
Chinese health reforms and evolving standards for accreditation of physicians and hospitals that
perform coronary catheterization and PCI.[17]
To address these gaps in knowledge and as a prelude to national quality improvement
efforts, we have leveraged the China PEACE (Patient-centered Evaluative Assessment of
Cardiac Events) research network to perform the China PEACE Retrospective Study of
Coronary Catheterization and Percutaneous Coronary Intervention (China PEACE-
Retrospective CathPCI Study). China PEACE is a collaborative effort between the China
National Center for Cardiovascular Diseases (NCCD); the Yale-New Haven Hospital Center for
Outcomes Research and Evaluation; the Chinese government; and a national network of
Chinese hospitals (Figure 1). The goal of the network is to generate new knowledge relevant to
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practice and policy and to translate this knowledge into action to improve care and outcomes for
patients with cardiovascular disease.
The China PEACE-Retrospective CathPCI Study will examine a nationally
representative sample of almost 12,000 patients who underwent coronary catheterization or PCI
from 55 Chinese hospitals during 2001, 2006, and 2011. This approach will permit the study of
care patterns and outcomes across hospitals, regions, and time during a dynamic period of
health care reform. The study is largely descriptive and rather than test a specific hypothesis
seeks to provide a foundation for future quality improvement and research. Specific aims of the
China PEACE-Retrospective CathPCI Study are: (1) to describe the characteristics of patients
undergoing coronary catheterization or PCI in China including their demographic,
socioeconomic, and clinical attributes; (2) to characterize patterns of treatment including the use
of procedural technologies and adjunctive therapies; (3) to describe in-hospital outcomes such
as mortality, treatment complications, length of stay, and hospital charges; (4) to characterize
differences in treatment and outcomes by patient characteristics, hospital, region, and year of
study; and (5) to examine adherence to quality measures for PCI. Research findings will be
shared with study hospitals and the Chinese government to improve both the selection of
patients for these procedures and their associated outcomes. In this paper, we describe study
methodology, abstracted data elements, planned statistical analyses, and initial enrollment of
sites.
METHODS AND ANALYSIS
Design Overview
We defined our study cohort based only on in-hospital coronary catheterizations, as
these procedures are not commonly performed on an outpatient basis in China. We included
patients undergoing coronary catheterization for any indication. We sampled eligible
hospitalizations for 2001, 2006, and 2011 from a network of nationally representative hospitals.
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We chose these 3 time periods to reflect the influence of major changes in the Chinese health
care system and the creation of PCI guidelines by Chinese medical societies (Figure 2).
To study 10-year trends in patient characteristics, treatment patterns, and outcomes
nationally and within regions of different socioeconomic development, we drew a representative,
stratified sample of patient discharges for each year. We intentionally drew a larger sample for
2011 to obtain more precise estimates of the current performance and variation in treatment
patterns and outcomes among hospitals.
The central ethics committee at the China NCCD approved the China PEACE-
Retrospective-CathPCI Study. All collaborating hospitals accepted the central ethics approval
except for 5 hospitals, which obtained local approval by internal ethics committees. The study is
registered at www.clinicaltrials.gov (NCT01624896).
The Chinese government, who provided financial support for the study, had no role in its
design or conduct; in the collection, management, analysis, and interpretation of the data; or in
the preparation or approval of the manuscript.
Sampling Design
We chose hospitals to reflect the diverse sites of care that perform coronary
catheterization and PCI. Candidate hospitals were limited to urban areas, as catheterization
capability is restricted almost exclusively to these regions. We identified urban areas using
official administrative divisions, in which a region is considered urban if it is part of a downtown
or suburban area within a direct-controlled municipality (Beijing, Tianjin, Shanghai, Chongqing)
or 1 of 283 prefectural-level cities. In total, Mainland China is composed of 287 urban regions.
As financial and medical resources are not identical throughout Mainland China, we separately
identified hospitals in each of its 3 official economic-geographic regions, i.e. Eastern, Central
and Western. As Central and Western urban regions have similar per capita income and health
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services capacity, we combined Central and Western regions into 1 stratum.[18] We then
identified hospitals separately for 2 study strata: Eastern-urban and Central/Western-urban.
We identified cases for study inclusion using a stratified 2-stage cluster sampling design
(Figure 3). In the first stage, we identified hospitals using a simple random sampling procedure
in each strata. The sampling framework consisted of the highest-level hospitals in each of the
predefined urban regions with the potential capability of performing PCI (833 hospitals in 287
urban regions). Hospital level is officially defined by the Chinese government based on clinical
resource capacity, e.g., secondary hospitals have at least 100 inpatient beds and the capacity to
provide acute medical care and preventive care services to populations of at least 100,000,
while tertiary hospitals are large referral centers in provincial capitals and major cities.[15, 19]
We excluded military hospitals, prison hospitals, specialized hospitals without a cardiovascular
disease division, and traditional Chinese medicine hospitals. We selected representative
hospitals from 2011 to reflect current practices and traced this same hospital cohort backward to
2006 and 2001 to describe temporal trends. As hospital number has grown by approximately
18% over the past decade,[20, 21] the cohort should be most representative of national
treatment patterns and outcomes in 2011.
In the second stage, we drew cases based on the local hospital database for patients
who underwent coronary catheterization or PCI at each sampled hospital using systematic
random sampling procedures. For each strata, we determined the sample size required to
achieve a 1.5% precision for describing the percentage of patients experiencing in-hospital
complications, which we estimated at 5%.[9, 22-25] To achieve a precision of 1.5% with an α of
0.05 in each stratum, assuming an intraclass correlation of 0.02 and design effect of 2.2, we
would need to sample 1,750 records among hospitals with an average cluster size of 60. This
cluster size appeared reasonable based upon national administrative data[26] and our previous
survey of treatment for acute coronary syndromes at more than 1000 hospitals in 2010, which
demonstrated that the median annual PCI volume was approximately 300 cases. Assuming a
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participation rate of 85% among selected hospitals, we approached 35 hospitals for participation
in each stratum for a total for 70 hospitals. We doubled cluster sizes for 2011 to improve
precision in the description of hospital-level treatment patterns and outcomes. Consequently,
the total expected sample volume with the above assumptions was approximately 3,500 cases
in 2001, 3,500 cases in 2006, and 7,000 cases in 2011. A more detailed description of the
sampling strategy is provided in the supplemental material within the online web appendix.
Data Collection
We trained staff at participating hospitals to identify all hospitalizations with coronary
catheterization or PCI procedures from their respective local hospital databases for 2001, 2006,
and 2011. After we sampled cases at each hospital, we assigned each case a unique study ID.
We then required local investigators to obtain the original record and transmit a scanned copy to
the coordinating center. To facilitate this process, the coordinating center provided each study
site with a high-speed scanner. To verify compliance with the case-finding strategy, research
staff from the coordinating center visited 60% of the sites to repeat the case-finding process,
confirm that the list of hospitalizations undergoing coronary catheterization or PCI was
complete, and assist in acquiring the sampled cases (Figure 3). We chose to visit study sites
that were expected to contribute a large volume of cases and have potential difficulties in
complying with the case finding strategy. These sites provided 73% of sampled cases.
Following receipt of the scanned record, research staff at the China NCCD ensured the
completeness and quality with which each medical record was copied. We required incomplete
or poorly scanned records to be rescanned and retransmitted (Figure 3). We instructed study
sites to include all parts of the medical record including the face sheet, admission note, daily
progress notes, procedure notes, medication administration record, diagnostic procedure
reports, laboratory test results, physician orders, nursing notes, and discharge summary.
The China PEACE-Retrospective CathPCI Study adhered to rigorous standards for
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abstraction. Before initiating chart review, each abstractor received 2 weeks of training that
included an introduction to the study, coronary heart disease and its subtypes, components of
the inpatient medical record including specialized sections such as catheterization reports, and
the China PEACE-Retrospective CathPCI Study data dictionary. We provided all material,
including the data dictionary, in Chinese. After training, we certified individuals who were able to
abstract 5 sample medical records with greater than 98% accuracy. Inexperienced abstractors
began with exclusively typewritten rather than hand-written medical records. In addition, we
randomly audited approximately 5% of the abstracted records. If the records were not
abstracted with 98% accuracy, all medical records in the audited batch were considered
unqualified and were re-reviewed by a different abstractor. Abstractors were required to
maintain this benchmark of 98% accuracy to retain certification. We used abstractors with
formal medical training to identify data elements requiring more advanced medical knowledge,
such as the development of post-procedural complications including bleeding or cardiac
tamponade. A physician was always present in the room with abstractors or was available
online to answer questions as they arose. We assigned medical records belonging to the same
hospital and year to a broad group of reviewers to avoid potential residual disparities in quality
among abstractors.
Data Management
We systematically perform ongoing data cleaning. Data managers regularly query data
for invalid and illogical values as well as for duplicate record entries. They identify potential
invalid values by searching for outliers in continuous data distributions. Records with identical
study identification numbers, hospital identification numbers, medical record identification
numbers, and dates of discharge trigger a search for duplicate records. Once a data query is
made, concerns are resolved after tracing and reviewing the relevant records.
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All data has been treated as protected health information and has been securely stored
in an encrypted and password protected database at the main coordinating center.
Data Elements
We examined both the English-language and Chinese literature for relevant studies to
create a list of candidate variables. We supplemented these elements with variables used in the
CathPCI Registry of the American College of Cardiology National Cardiovascular Data Registry
(NCDR). CathPCI is an outcomes-based registry and quality improvement program that focuses
on patients who undergo coronary catheterization and PCI in the United States. Incorporating
variables from CathPCI will permit cross-country comparisons in resource utilization and
adherence to quality metrics. We also incorporated elements from the case report form used in
the China PEACE-Retrospective Study of Acute Myocardial Infarction[27] (clinicaltrials.gov
identifier NCT01624883) to permit comparison of hospitalizations for acute myocardial infarction
between these 2 China PEACE studies. Major categories of data elements are described in
Table 1.
Table 1. China PEACE-Retrospective CathPCI Study Data Elements
Category Example Elements
Patient demographics Age, sex, ethnicity, postal code, occupation, insurance status
Medical history Diabetes, hypertension, hyperlipidemia, vascular disease, prior
revascularization
Initial cardiac status Heart rate, blood pressure, Killip class, heart failure, cardiac arrest
Lab values Troponin, CK, CK-MB, BNP, sodium, BUN, creatinine, WBC
count, hemoglobin
Diagnostic procedures Coronary catheterization, echocardiogram, CT angiogram, stress
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testing, chest radiograph
Medications including dose Anti-platelet therapy, anti-coagulant therapy, beta blocker, ACE
inhibitor/ARB, statin, traditional Chinese medicines
Auxiliary imaging Intravascular ultrasound, fractionated-flow reserve
Coronary flow dynamics Pre-procedural TIMI flow, post-procedural TIMI flow
Revascularization Fibrinolysis, PCI (access, coronary anatomy, bypass graft
anatomy, stent number, stent type, stent length, contrast dose,
closure device), CABG surgery
Mechanical support Intra-aortic balloon pump, left ventricular assist device, ECMO
Outcomes including in-
hospital complications
Death, myocardial infarction, heart failure, shock, arrhythmia,
stroke, bleeding, transfusion, infection, coronary perforation,
coronary dissection
ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BNP, brain natriuretic
peptide; BUN, blood urea nitrogen; CABG, coronary artery bypass graft; CK, creatine kinase;
CK-MB, creatine kinase-MB; CT, computed tomography; ECMO, extracorporeal membrane
oxygenation; PCI, percutaneous coronary intervention; TIMI, Thrombolysis in Myocardial
Infarction; WBC, white blood cell
In Table 2, we show data relevant to performance measures during the first 24 hours of
hospitalization and at hospital discharge for patients with acute myocardial infarction and those
undergoing PCI for stable coronary artery disease.
Table 2. China PEACE-Retrospective CathPCI Study Performance Measures
First 24 Hours Discharge
Aspirin Aspirin*
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Time to primary PCI Thienopyridine*
Time to fibrinolysis Beta blocker
ACE inhibitor or ARB for LV systolic dysfunction
Statin*
Smoking cessation counseling
Cardiac rehabilitation referral
All performance measures apply to patients with acute myocardial infarction. Performance
measures with asterisks also apply to patients undergoing PCI for stable coronary artery
disease. ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; LV, left
ventricle; PCI, percutaneous coronary intervention
Where possible, we collected data that would allow us to construct the core quality measures for
acute myocardial infarction used and reported by the Centers for Medicare & Medicaid Services
in the United States as well as the quality measures for PCI from the NCDR.[28] Two physician
investigators at each participating hospital also completed a survey, modeled on the annual
survey of hospitals performed by the American Hospital Association, of its major structural and
organizational characteristics during the study period.[29] Key variables assessed include bed
size, teaching status, and capability of performing coronary artery bypass graft surgery.
Statistical Analyses
We will report summary statistics for patient characteristics, use of diagnostic tests,
treatments received, and in-hospital outcomes including complications of care and
hospitalization costs across study sites. Weighting will reflect the reciprocal of sampling
probability. For each aim, we will use standard parametric and non-parametric techniques for
observational data, including t tests, chi-square tests, Wilcoxon rank sum tests, and generalized
linear models. Because patient characteristics, treatments, and outcomes may be correlated
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within hospitals, analyses will account for the effect of clustering. To examine and adjust for
differences between comparison groups, we will use linear, logistic, Cox proportional hazard,
and Poisson models with a generalized estimating equation approach and hierarchical models,
where appropriate. We will develop models to stratify patients according to their risk of adverse
outcomes. We will assess the relationship of candidate variables to in-hospital outcomes using
appropriate statistical techniques for the dependent variable. We will further refine the list of
candidate variables based on their clinical relevance.
Progress to Date
As of December 2012, 55 hospitals agreed to participate in the study. Fifteen hospitals
did not participate because they did not provide inpatient services for coronary heart disease (5
hospitals), were incapable of performing coronary catheterization and PCI throughout the study
period (8 hospitals), or refused to participate (2 hospitals). Of the 55 participating hospitals, 29
were located in the Eastern economic-geographic stratum and 26 were located in the
Central/Western economic-geographic stratum. The distribution of sites by province and region
is shown in Figure 4.
In parallel with national trends, the number of hospitals providing cases increased with
each subsequent year of study. In 2001, 26 of the 55 participating hospitals were capable of
performing PCI, of which 24 submitted medical records. Of the 2 hospitals that did not submit
records, 1 did not keep records in 2001 and the other had its records destroyed by a fire. Both
of these institutions likely had very limited capacity for PCI in 2001, as evidenced by their
performance of only 16 and 28 respective cases of coronary catheterization and PCI in 2006. A
total of 44 hospitals performed PCI in 2006, all of which submitted records to the study. Fifty-
four hospitals performed catheterization and PCI in 2011. As with 2006, all hospitals that
performed PCI in 2011 submitted records.
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We collected all medical records for abstraction by December 2012. The examination of
census databases from participating hospitals yielded 58,008 hospitalizations for coronary
catheterization and PCI (3,270 in 2001, 12,875 in 2006, and 41,863 in 2011). Of these 58,008
hospitalizations, we sampled 12,477 (22%) [1,444 (44%) in 2001, 3,046 (24%) in 2006, and
7,987 (19%) in 2011]. Of these 12,477 sampled hospitalizations, we acquired medical records
for 11,900 (95%); 577 (5%) medical records could not be found due to poor archiving. We
began data abstraction of these medical records in March 2013 and expect abstraction to be
completed in January 2014.
DISCUSSION
Through use of a national research network, the China PEACE-Retrospective CathPCI
Study is developing a repository of data that describes the current and former use of coronary
catheterization and PCI in China. This project will provide answers to questions about
contemporary practice patterns including variation among institutions and temporal trends in
procedure use and adjunctive therapy. To elevate the quality of abstracted data, the study uses
data collection techniques regularly employed by international clinical trials such as integrated
central and on-site monitoring as well as source document checking. The China PEACE-
Retrospective CathPCI Study also elicits the active participation of hospitals across China to
ensure that study results disseminate broadly for the purpose of quality improvement. Findings
will be shared with government to help research findings inform policy. The study is designed to
guide the efficient allocation and high-quality use of advanced cardiovascular interventions in
the context of a rapidly growing cardiovascular disease burden and dynamically changing health
care system.
The China PEACE-Retrospective CathPCI Study falls under the larger China PEACE
effort, which aims to create a national research network dedicated to improving cardiovascular
outcomes. China PEACE is built on a platform of collaboration and coordination between
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clinicians, researchers, and policy makers. With this framework in mind, study sites do not
merely transmit information to the coordinating center, but are full partners and consumers of
the knowledge generated. In this way, China PEACE has similarities to the NCDR CathPCI
Registry of the American College of Cardiology, which provides participating hospitals with
regular performance reports including analysis of process measures and in-hospital outcomes.
The Chinese government, a partner in China PEACE, will use study results to develop
policies intended to strengthen the clinical performance of the hospitals. The goal is not simply
to identify poor performing institutions, but to use a shared learning approach to elevate care
delivery at all participating hospitals and produce knowledge that is broadly applicable across
sites of care, including those external to the China PEACE network. In the future, we hope to
directly involve patients and caregivers in designing study questions and disseminating findings.
We anticipate that the results of the China PEACE-Retrospective CathPCI study will
illuminate the effects of recent health care reforms in China on the use of coronary
catheterization and PCI. Although China has adopted policies to enhance quality of care and
dissemination of novel technologies over the past decades,[17] they have been applied
differentially across the country.[26] After the first PCI was performed in China in 1985,[5] there
followed a period of unregulated dissemination.[30, 31] In 2000, most patients paid for PCI
themselves, and there was widespread variation in access to the technology.[6, 7] Access was
subsequently improved in 2003 with the implementation of the Rural Cooperative Medical Care
Scheme that expanded insurance access to the low-income rural population. This government
initiative was followed by additional health care reforms in the latter half of the decade that
further expanded insurance support for both rural and urban residents.[6, 7] In this context, the
Ministry of Health established processes for accreditation of interventional centers in 2007 to
promote minimal quality standards for PCI.[17] Through our nationally representative and multi-
year sample of catheterization and PCI, we will have the capacity to evaluate the temporal
influence of these polices on practice patterns and its variability by hospital and region. We may
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identify signals of potential inefficient allocation of resources such as the use of drug-eluting
stents in situations where bare-metal stents are similarly efficacious. Results may prove useful
to future policymaking and guideline development.
We also expect that the knowledge generated from the China PEACE-Retrospective
CathPCI Study will be useful internationally. Many low- and middle-income countries are
undergoing a similar epidemiological transition and are experiencing comparable challenges
associated with a growing number of persons with chronic cardiovascular disease and rapidly
rising health care costs in the setting of limited health care resources.[32] The experience with
China PEACE may help guide other countries in their desire to learn about trajectories and
variation in the use of novel health technologies. Developed nations are also facing common
challenges around health care reform and the optimal utilization of advanced interventions.[33]
The development of novel approaches to care in China may have relevance for more wealthy
countries that are grappling with escalating costs and trying to determine whether reduction in
resource expenditures can be achieved without compromising patient outcomes.
The China PEACE-Retrospective CathPCI Study is distinguished from many
retrospective analyses by its use of data quality control strategies that are common in the
performance of multicenter clinical trials. The study has devoted significant attention to data
quality at multiple stages including case ascertainment, data abstraction, and data
management. For example, research staff visited study sites to identify all hospitalizations
involving coronary catheterization or PCI from local hospital databases and physically found all
medical records for sampled cases whenever possible. In addition, all abstractors underwent
standardized training at the coordinating center and continued to maintain high standards for
accuracy to remain certified. Medical records reviewed by abstractors who fail to meet
continuing recertification requirements are always re-abstracted. These and other quality control
and assurance strategies are the result of the NCCD’s previous experience in conducting
cardiovascular clinical trials in China.
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This study has some limitations, including those inherent to its retrospective design.
Findings depend on the accuracy and completeness of the medical records, and the abstraction
process. However, these limitations would apply to all retrospective studies. Moreover, the
identification of poor documentation of key variables is crucial to future quality improvement
measurements. Our study is not designed to track outcomes following hospitalization or the
experience of patients. These variables, however, will be collected in the recently launched
Prospective Study of PCI from the China PEACE platform. Finally, in our sampled hospital
cohort, catheterization and PCI volume was smaller than expected for the year 2001, in
particular, as the number of hospitals capable of performing PCI and the PCI volume per center
were relatively low. However, the sample remains nationally representative in the last year and
can still provide acceptable precision in describing 10-year trends (supplemental material within
online web appendix).
The China PEACE-Retrospective CathPCI Study, one of the first studies to be launched
from the China PEACE platform, seeks to assess the characteristics, treatments, and outcomes
of patients who receive diagnostic catheterization and PCI in a large nationally representative
sample of hospitals in China. It provides a unique opportunity to compare variation in care and
to assess trajectories in practice in the context of an era of rapid adoption of new cardiovascular
technologies and constrained health care resources. Findings are intended guide the more
efficient use of coronary catheterization and PCI in a manner that improves health outcomes
across diverse geographic settings and sites of care within China.
ETHICS AND DISSEMINATION
The central ethics committee at the China NCCD approved the China PEACE-
Retrospective-CathPCI Study. Ethics approval was also obtained from all collaborating
hospitals. The study is registered at www.clinicaltrials.gov (NCT01624896). The Chinese
government, who provided financial support for the study, had no role in its design or conduct; in
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the collection, management, analysis, and interpretation of the data; or in the preparation or
approval of this manuscript.
Study findings will be freely shared with participating hospitals and the Chinese
government. To improve health care quality, data will be presented in the format of regular
performance reports that include analysis of both process measures and in-hospital outcomes.
Findings will also be disseminated via peer-reviewed publications. Requests for collaboration
will be welcomed.
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Acknowledgments: We appreciate the multiple contributions made by study teams at the
China Oxford Centre for International Health Research and the Yale-New Haven Hospital
Center for Outcomes Research and Evaluation in the realms of study design and operations.
We are grateful for the support provided by the Chinese government.
Contributor statement. JL and KD made substantial contributions to study conception and
design, drafting of the manuscript, and critical revision of the manuscript for important
intellectual content. XL, ZL, and SLTN made substantial contributions to study conception and
design and critical revision of the manuscript for important intellectual content. HMK and LJ
made substantial contributions to study conception and design, drafting of the manuscript,
critical revision of the manuscript for important intellectual content, and provided administrative,
technical, and material support, including study supervision.
Competing interests. Dr. Krumholz reports being the recipient of a research grant from
Medtronic, Inc. through Yale University and the chair of a cardiac scientific advisory board for
UnitedHealth. The authors declare no other relevant competing interests.
Funding statement. This project was partly supported by grant 201202025 from the Ministry of
Health of China. At the time this study was initiated, Dr. Dharmarajan was supported by grant
HL007854 from the National Heart, Lung, and Blood Institute; he was also supported as a
Centers of Excellence Scholar in Geriatric Medicine at Yale by the John A. Hartford Foundation
and the American Federation for Aging Research. The sponsors had no role in the conduct of
the study; in the collection, management, analysis, and interpretation of the data; or in the
preparation or approval of the manuscript.
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Ethical approval. The central ethics committee at the China NCCD approved the China
PEACE-Retrospective-CathPCI Study. All collaborating hospitals accepted the central ethics
approval except for 5 hospitals, which obtained local approval by internal ethics committees.
The study is registered at www.clinicaltrials.gov (NCT01624896).
Transparency declaration. LJ affirms that this manuscript is an honest, accurate, and
transparent account of the study protocol being reported; that no important aspects of the study
protocol have been omitted; and that any discrepancies from the study protocol as planned
(and, if relevant, registered) have been explained.
Data sharing. No additional data is directly available. However, requests for collaboration are
welcome.
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REFERENCES
1. He J, Gu D, Wu X, et al. Major causes of death among men and women in China. N
Engl J Med 2005;353:1124-34.
2. Moran A, Gu D, Zhao D, et al. Future cardiovascular disease in China: Markov model
and risk factor scenario projections from the coronary heart disease policy model-China. Circ
Cardiovasc Qual Outcomes 2010;3:243-52.
3. Yang G, Kong L, Zhao W, et al. Emergence of chronic non-communicable diseases in
China. Lancet 2008;372:1697-705.
4. Gao R. The development of percutaneous cardiovascular intervention in China.
http://www.cmt.com.cn/detail/39179.html (accessed 17 September 2013).
5. Gao R. Current status of percutaneous coronary intervention in China. Heart
2010;96:415-18.
6. Cao Q, Shi L, Wang H, et al. Report from China: health insurance in China--evolution,
current status, and challenges. Int J Health Serv 2012;42:177-95.
7. Hu S, Tang S, Liu Y, et al. Reform of how health care is paid for in China: challenges
and opportunities. Lancet 2008;372:1846-53.
8. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes
of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of
Disease Study 2010. Lancet 2012;380:2095-128.
9. Section of Interventional Cardiology, Chinese Society of Cardiology. A data analysis of
the third national coronary intervention registry. Chin J Cardiol 2002;30:719-23.
10. Lu SZ, Song XT, Chen YD, et al. Findings from registry of percutaneous coronary
intervention in inland of China. Zhonghua Xin Xue Guan Bing Za Zhi 2009;37:26-9.
11. Lu SZ, Song XT, Chen YD, et al. Beyond the numerals: primary reports from Registry of
PCI In China (ROPIC). Zhonghua Xin Xue Guan Bing Za Zhi 2006;34:966-70.
Page 22 of 207
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on Decem
ber 2, 2020 by guest. Protected by copyright.
http://bmjopen.bm
j.com/
BM
J Open: first published as 10.1136/bm
jopen-2013-004595 on 7 March 2014. D
ownloaded from
For peer review only
23
12. Yuan F, Song XT, Lu SZ. Percutaneous coronary intervention in mainland China in
2008: register results. Zhonghua Xin Xue Guan Bing Za Zhi 2010;38:629-32.
13. Song XT, Du MY, Yuan F, et al. Cost-utility analysis of percutaneous coronary
intervention in 13 cities of China. Zhonghua Xin Xue Guan Bing Za Zhi 2010;38:484-87.
14. Yu LT, Zhu J, Mister R, et al. The Chinese registry on reperfusion strategies and
outcomes in ST-elevation myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi
2006;34:593-97.
15. Gao R, Patel A, Gao W, et al. Prospective observational study of acute coronary
syndromes in China: practice patterns and outcomes. Heart 2008;94:554-60.
16. Liu SW, Xu B, Chen J, et al. Trends in in-hospital outcome after percutaneous coronary
intervention in the drug-eluting stents era. Clin Cardiol 2010;33:516-21.
17. Ministry of Health of the People's Republic of China. Regulation about cardiovascular
interventional techniques 2007. http://www.moh.gov.cn/mohbgt/pw10712/200804/18725.shtml
(accessed 17 September 2013).
18. National Bureau of Statistics of China. 2010 China statistical yearbook.
http://www.stats.gov.cn/tjsj/ndsj/2010/indexeh.htm (accessed 17 September 2013).
19. Ministry of Health of the People's Republic of China. The performance evaluation
standards for general hospitals (revised version).
http://www.moh.gov.cn/cmsresources/mohbgt/cmsrsdocument/doc6535.pdf (accessed 17
September 2013).
20. Ministry of Health of the People's Republic of China. China public health statistical
yearbook 2003. Beijing: Peking Union Medical College Publishing House; 2003.
21. Ministry of Health of the People's Republic of China. China public health statistical
yearbook 2012. Beijing: Peking Union Medical College Publishing House; 2012.
22. Venkitachalam L, Kip KE, Selzer F, et al. Twenty-year evolution of percutaneous
coronary intervention and its impact on clinical outcomes: A report from the National Heart,
Page 23 of 207
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
on Decem
ber 2, 2020 by guest. Protected by copyright.
http://bmjopen.bm
j.com/
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J Open: first published as 10.1136/bm
jopen-2013-004595 on 7 March 2014. D
ownloaded from
For peer review only
24
Lung, and Blood Institute–sponsored, multicenter 1985–1986 PTCA and 1997–2006 dynamic
registries. Circ Cardiovasc Interv 2009;2:6-13.
23. Li Y, Li CX, Wang HC, et al. Efficacy and safety of Firebird sirolimus-eluting stent in
treatment of complex coronary lesions in Chinese patients: one-year clinical and eight-month
angiographic outcomes from the FIREMAN registry. Chin Med J 2011;124:817-24.
24. Koh A, Khin L, Choi L, et al. Percutaneous coronary intervention in asians- are there
differences in clinical outcome? BMC Cardiovasc Disord 2011;11:22.
25. Chinese PLA Cardiology Society. Analysis of the third (from 2003 to 2004) PLA coronary
intervention therapy registry. Medical Journal of Chinese People's Liberation Army 2006;31:60-
64.
26. Huo Y. Current status and development of percutaneous coronary intervention in China.
J Zhejiang Univ Sci B 2010;11:631-33.
27. Dharmarajan K, Li J, Li X, et al. The China Patient-Centered Evaluative Assessment of
Cardiac Events (China PEACE) Retrospective Study of Acute Myocardial Infarction: Study
Design. Circ Cardiovasc Qual Outcomes 2013;6:732-40.
28. National Cardiovascular Data Registry. NCDR quality metrics and measures.
https://www.ncdr.com/WebNCDR/home/metrics-and-measures (accessed 17 September 2013).
29. American Hospital Association. AHA annual survey database fiscal year 2011.
http://www.ahadataviewer.com/book-cd-products/aha-survey/ (accessed 17 September 2013).
30. Chinese Society of Cardiology, Chinese Society of Cardiology Editorial Board. 2002
Chinese guideline for percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi
2002;30:707-18.
31. Chinese Society of Cardiology, Chinese Society of Cardiology Editorial Board. 2009
Chinese guideline for percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi
2009;37:4-25.
Page 24 of 207
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open
123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
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http://bmjopen.bm
j.com/
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J Open: first published as 10.1136/bm
jopen-2013-004595 on 7 March 2014. D
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For peer review only
25
32. Nugent R. Chronic diseases in developing countries: health and economic burdens. Ann
NY Acad Sci 2008;1136:70-79.
33. Blumenthal D, Dixon J. Health-care reforms in the USA and England: areas for useful
learning. Lancet 2012;380:1352-57.
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FIGURE LEGEND
Figure 1. The China PEACE Initiative. Key partners include the Chinese government,
collaborating hospitals, the China National Center for Cardiovascular Diseases, and the Yale-
New Haven Hospital Center for Outcomes Research and Evaluation. The China PEACE-
Retrospective CathPCI Study is 1 of 5 initial studies from the China PEACE initiative. The topic
areas for these 5 projects concern acute myocardial infarction, coronary
catheterization/percutaneous coronary intervention, and multi-vessel coronary artery disease.
Future studies will focus on cerebrovascular disease and other cardiovascular conditions.
AMI, acute myocardial infarction; PCI, percutaneous coronary intervention; 3VD, triple-vessel
coronary artery disease
Figure 2. Chinese Trends in PCI Volume from 2001 to 2011. Figure demonstrates the increase
in PCI volume by year and the increase in the number of hospitals performing >100 PCIs per
year. Notable events pertinent to the expansion in PCI access with time are highlighted below
the graph. In 2003, the Rural Cooperative Medical Care System expanded health insurance to
low-income rural residents. The health care reform of 2007 substantially expanded health
spending for both the rural and urban population. We sampled eligible hospitalizations for 2001,
2006, and 2011. PCI, percutaneous coronary intervention.
Figure 3. The China PEACE-Retrospective CathPCI Study Flow Chart and Associated Quality
Assurance Strategies. Flow chart should be read from top to bottom. CRF, case report form; Q
& A, questions and answers.
Figure 4. Geographic Distribution of Participating Hospitals in the China PEACE-Retrospective
CathPCI Study. Of 70 sampled hospitals, 15 were unable or unwilling to participate and 55
provided cases for the study.
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WEB APPENDICES: SUPPLEMENTAL MATERIAL Protocol of the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Retrospective Study of Coronary Catheterization and Percutaneous Coronary Intervention The China PEACE Collaborative Group1, 2
1State Key Laboratory of Cardiovascular Disease, China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China; 2The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States
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TABLE OF CONTENTS Page(s) 2 Table of Contents 3-5 China PEACE-Retrospective CathPCI Study Sampling Design 6 China PEACE-Retrospective CathPCI Study Absolute Precision Achieved for in-
Hospital Complications 7 China PEACE-Retrospective CathPCI Study Quality Assurance and Quality
Control Strategies in Medical Record Sampling 8-9 China PEACE-Retrospective CathPCI Study Quality Assurance and Quality
Control Strategies in Medical Record Abstraction 10-41 China PEACE-Retrospective CathPCI Study Case Report Form, Part 1 42-57 China PEACE-Retrospective CathPCI Study Case Report Form, Part 2 58-172 China PEACE-Retrospective CathPCI Study Data Dictionary 173 China PEACE-Retrospective CathPCI Study Site Investigators by Hospital 174 China PEACE Study Consultants
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY SAMPLING DESIGN
We intended study hospitals to reflect the diverse sites of care performing coronary catheterization and percutaneous coronary intervention (PCI) in China. We restricted hospitals to those in urban areas, as coronary catheterization and PCI are rarely performed in rural areas. We considered an area urban if it is part of a downtown or suburban area within a direct-controlled municipality (Beijing, Tianjin, Shanghai, Chongqing) or 1 of 283 prefectural-level cities. As financial and medical resources are not identical throughout Mainland China, we separately identified hospitals in each of China’s 3 official economic-geographic regions, i.e. Eastern, Central and Western. As Central and Western urban regions have similar per capita income and health services capacity, as shown below, we combined Central and Western regions into 1 stratum.
Population, Economy, and Hospitals in Urban Areas of Different Geographic Strata of Mainland China
Eastern Central Western
Total Population* 336,364,491 150,467,917 144,803,916
Income per capita (RMB)† 21,547 15,539 15,523
Number of urban areas in strata‡ 121 81 85
Median # of hospitals per urban area (IQR)¶¶¶¶
Tertiary hospitals 3 (2-6) 2 (1-3) 2 (1-4)
Secondary hospitals 5 (3-8) 4 (3-6) 3 (2-6)
*Statistics in 2009 from the National Bureau of Statistics of China (http://www.stats.gov.cn/tjsj/ndsj/2010/indexch.htm) †Statistics (RMB) in 2009 from the National Bureau of Statistics of China
(http://www.stats.gov.cn/tjsj/ndsj/2010/indexch.htm) ‡Administrative divisions code (October 31, 2011) in China (http://www.stats.gov.cn/tjbz/xzqhdm/t20120105_402777427.htm) ¶Median (interquartile range)
We then identified hospitals separately for 2 study strata: Eastern-urban and Central/Western-urban regions.
We identified cases for study inclusion using a stratified 2-stage cluster sampling design. In the first stage, we identified hospitals using a simple random sampling procedure within each of the 2 study strata. The sampling framework consisted of the highest-level hospitals in each of the predefined urban regions (833 hospitals in 287 urban regions). Hospital level is officially defined by the Chinese government based on clinical resource capacity. For example, secondary hospitals have at least 100 inpatient beds and the capacity to provide acute medical care and preventive care services to populations of at least 100,000, while tertiary hospitals are large referral centers in provincial capitals and major cities. We excluded military hospitals, prison hospitals, specialized hospitals without a cardiovascular disease division, and traditional Chinese medicine hospitals. Since the number of hospitals has remained stable over the past decade, we decided to select representative hospitals from 2011 to reflect current practices and trace this hospital cohort backward to 2006 and 2001 to describe temporal trends.
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In the second stage, we drew cases based on the local hospital database for patients who
underwent coronary catheterization at each sampled hospital. We ordered each hospital’s list of eligible cases by date of coronary catheterization and selected cases using systematic random sampling with equal probabilities. We selected a case at random, after which we selected every kth case based on sample size requirements, where k is the sampling interval. In each study stratum, we determined the sample size required to achieve a 1.5% precision for describing the rate of in-hospital complications, which we had estimated to be approximately 5%.
The following Equation 1 can be used to define the sample size required (n) for a given proportion of the primary outcome (P), desired precision (d), and specific choice of α.1 Equation 1:
� ��∝
� ∙ ��1 ��
��
However, because random cases sampled within the same hospital are likely to be more similar to one another than to random cases from another hospital, the effective sample size is reduced. Consequently, a design effect adjustment should be introduced as follows: Equation 2:
� ��∝
� ∙ ��1 ��
�� ����
Where the design effect (deff) is given by
Equation 3:
���� � 1 � ���′� 1�
where � is the intraclass correlation for the statistic in question and �′� is the average number of
sampled cases within each hospital. �′� is also known as the cluster size.
With this framework in mind, to achieve a precision of 1.5% with an α of 0.05 in each stratum, assuming an intraclass correlation of 0.02 and design effect of 2.2, we would need to sample 1750 medical records among hospitals with an average cluster size of 60. These cluster sizes in urban settings appeared reasonable based upon our previous survey of treatment for acute coronary syndromes at more than 1000 hospitals in 2010, which demonstrated that the median PCI volume was approximately 300 cases per year. Assuming a participation rate of 85% among selected hospitals, we approached 35 hospitals for participation in each stratum for a total of 70 hospitals. We doubled cluster sizes for 2011 to improve precision in the description of hospital-level treatment patterns and outcomes. Consequently, the total expected sample volume with the above assumptions was
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approximately 3,500 cases in 2001, 3,500 cases in 2006, and 7,000 cases in 2011.
Reference 1. Machin D, Campbell M, Fayers P, Pinol A. Sample size tables for clinical studies, 2nd
edition. Malden, MA: Blackwell Science; 1997.
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY ABSOLUTE PRECISION ACHIEVED FOR IN-HOSPITAL COMPLICATIONS IN STUDY STRATA
Study Stratum Sample Size Achieved
Average Cluster Size
deff Precision Achieved for Proportion of 0.05
Actual Data*
Central/Western-urban in 2001 519 17 1.3 2.1%
Central/Western-urban in 2006 1,131 36 1.7 1.6%
Central/Western-urban in 2011 3,662 118 3.3 1.3%
Eastern-urban in 2001 925 29 1.6 1.7%
Eastern-urban in 2006 1,915 60 2.2 1.5%
Eastern-urban in 2011 4,325 135 3.7 1.3%
Anticipated Data†
2001 or 2006 1,750 60 2.2 1.4%
2011 3,500 120 3.3 1.3%
* Actual data reflects the absolute precision achieved in describing in-hospital mortality in each stratum during 2001, 2006, and 2011 based upon the actual sample size, actual average cluster size, and associated design effect. † Anticipated data reflects the anticipated absolute precision that would be achieved in describing in-hospital mortality in each stratum during 2001, 2006, and 2011 based upon the anticipated sample size, anticipated average cluster size, and associated design effect.
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY QUALITY ASSURANCE AND QUALITY CONTROL STRATEGIES IN MEDICAL RECORD SAMPLING As the China PEACE Retrospective Study of Coronary Catheterization and Percutaneous Coronary Intervention was designed to study a nationally representative hospital cohort, we selected hospitals based on random sampling rather than previous collaboration or longstanding experience with retrospective data collection. As we anticipated that many hospitals would have little previous experience with clinical research, we provided participating sites with substantial support to ensure adherence with multiple quality control strategies for identifying all hospitalizations undergoing coronary catheterization and for randomly selecting eligible hospitalizations for the China PEACE-Retrospective CathPCI Study. For all participating hospitals, we first held a local investigator meeting to provide in-depth information on study design and operating procedures. We trained sites on how to identify all hospitalizations undergoing coronary catheterization or percutaneous coronary intervention. The sites identified eligible hospitalizations by searching their electronic database or hard-copy log during the specified time periods. To verify compliance with the search strategy, research staff from the study coordinating center visited 33 study sites to repeat the case finding process and confirm that the list of hospitalizations undergoing coronary catheterization and/or PCI was complete. These 33 sites provided 83%of all hospitalizations undergoing coronary catheterization/PCI from which we sampled cases for the PEACE Retrospective CathPCI Study. After we sampled cases at each hospital using systematic random sampling and assigned each record a unique study ID, we required local investigators to gather the original record, assign it its study ID, scan it, and transmit the scanned copy to the coordinating center. Upon receipt of the scanned record, coordinating center staff verified the consistency of the hospitalization ID and procedure date with the sampled case, and ensured that the record itself was complete and legible. To facilitate this process, the coordinating center provided each study site with a high-speed scanner. In addition, coordinating center staff provided on-site assistance for 33 study sites that provided approximately 73% of sampled cases. To ensure transparency in all sampling performed by the NCCD, we have recorded all sampling procedures including the contents of the sampling framework database that contains all eligible cases for sampling in their predefined sequence and the seeds used in random number generation.
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY QUALITY ASSURANCE AND QUALITY CONTROL STRATEGIES IN MEDICAL RECORD ABSTRACTION Background Medical record abstraction can be guided by the types of data being abstracted. We have defined as simple data elements those elements that can be abstracted directly from the chart without use of professional judgment. Examples include the date of admission, patient sex, patient age, serum creatinine on hospital day 1, etc. In contrast, complex data elements are those that require more advanced medical knowledge for abstraction. Examples of complex data elements include the presence of comorbidities, evidence of pulmonary edema on hospital presentation, development of post-procedural complications such as bleeding or arrhythmia, and so on. Within the Chinese medical record, simple data elements are found predominantly in the medical record face sheet, section for laboratory testing results and physician orders. Complex elements are found throughout all other sections of the medical record including the admission record, discharge record and diagnostic reports, etc. Training and Qualification of Abstractors The abstractors for simple data elements were clerks with experience in medical record abstraction. The abstractors for complex data elements were undergraduate or post-graduate trainees. Most were medical students. Each abstractor was given a set of training materials about medical record abstraction, including CHINA PEACE: A Brief Introduction, China PEACE: Operation Manual of Medical Record Abstraction, and 5 standard training medical records. Each abstractor also underwent the following training courses: (1) Introduction to the China PEACE protocol; (2) Coronary heart disease and its subtypes; (3) Component parts of the inpatient medical record and their contents; (4) China PEACE Retrospective Study of Coronary Catheterization and Percutaneous Coronary Intervention data dictionary; (5) Frequently asked questions in medical record abstraction; (6) Quality assurance and quality control measures in China PEACE; and (7) Intensive guidance in abstracting 5 standard training medical records followed by group discussion and retraining as needed. Once training was completed, each abstractor reviewed 5 standard training medical records. Supervisors were responsible for evaluating the accuracy of abstraction. Every abstractor needed to achieve greater than 98 percent abstraction accuracy in order to be considered competent. Quality Control in Medical Record Abstraction We randomly audit approximately 5% of the abstracted records. If the records have not been abstracted with 98% accuracy, all records in the audited batch are considered unqualified and are re-reviewed by a different abstractor. Discrepancies in abstraction are resolved by review of the original medical record.
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To minimize abstraction errors, abstractors start by abstracting only printed medical records. After gaining experience, these individuals are allowed to begin abstracting hand-written records. In addition, a physician is always present in the room with abstractors or is available online to answer questions and address areas of concern as they arise. Common problems have led to updates of the data dictionary and database into which data are directly entered. This database has been additionally customized to expedite the identification of medications that may have more than one trade name. Furthermore, medical records belonging to the same hospital and year are assigned to a broad group of reviewers to avoid potential residual disparities in quality among different abstractors Data Management and Cleaning Ongoing data cleaning is performed in a systematic manner. Data is regularly queried for invalid and illogical values as well as for duplicate record entry. Outliers in continuous data distributions are identified as potentially invalid and are further explored. Duplicate records are identified by the presence of identical study identification numbers, hospital identification numbers, medical record identification numbers, and dates of discharge. Once a data query is made, concerns are resolved after tracing and reviewing the relevant records.
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY CASE REPORT FORM, PART I Contents Face Sheet ............................................................................................................................... 11 Discharge Records ................................................................................................................. 111 Admission Records & History of Diseases .............................................................................. 188 Personal History ........................................................................................................................21 Physical Examination ................................................................................................................21 Auxiliary Examination ................................................................................................................22 Preliminary Diagnosis ............................................................................................................. 255 Daily Records ......................................................................................................................... 266 In-Hospital Device Placement ...................................................................................................30 Coronary Angiography and PCI Report .....................................................................................30 CABG Report ............................................................................................................................36 Imaging Examination.................................................................................................................36 In-Hospital ECG ...................................................................................................................... 377 Temperature Report ..................................................................................................................38 Long-term Physician Orders ......................................................................................................38 Short-term Physician Orders .....................................................................................................39 Discharge Medications ..............................................................................................................40 Note: The case report form parallels common sections of the Chinese medical record. In certain instances, questions within the case report form have been repeated for different sections of the medical record to maximize the sensitivity of abstraction.
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1 Study ID _____【【【【Free Text (F)】】】】
Face Sheet
2.1 Medical Record Number _____【【【【F】】】】
2.2 Hospital Number _____【【【【F】】】】
3 Gender【【【【Single Choice (SC)】】】】 --Male --Female
4 Age _____yrs【【【【F】】】】
5.1 Admission Date _____【【【【Select Date from Calendar (C)】】】】
5.2 Admission Time _____【【【【F】】】】
Discharge Records
6 In-Hospital Death【【【【SC】】】】 --Yes --No
7 In-Hospital Death Date _____【【【【C】】】】
8 Admission Diagnosis (Related to Coronary Heart Disease)
【【【【Multiple Choices Permitted (MC)】】】】 --Coronary Heart Disease --Acute Coronary Syndrome --Acute Extensive Anterior Myocardial Infarction --Acute Myocardial Infarction --Acute Anterior Myocardial Infarction --Acute Septal Myocardial Infarction --Acute Inferior Myocardial Infarction --Acute Lateral Myocardial Infarction --Acute Posterior Myocardial Infarction --Acute Right Ventricular Myocardial Infarction --Acute Non ST-Elevation Myocardial Infarction --Acute ST-Elevation Myocardial Infarction --Subendocardial Myocardial Infarction --Acute Myocardial Infarction Suspected --Previous (Q-wave) Myocardial Infarction --Unstable Angina Pectoris --Stable Angina Pectoris --Prinzmetal's Angina --Angina (Unrecorded Subtype)
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--None of the Above Is Recorded
9 Admission Diagnosis (Unrelated to Coronary Heart Disease)【【【【MC】】】】 --Cardiac Arrest --Cardiogenic Shock --Ventricular Fibrillation/Ventricular Tachycardia --Atrial Fibrillation --Acute Heart Failure --Chronic Heart Failure --Heart Failure (Unspecified) --Acute Pulmonary Edema --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Ischemic Stroke (Cerebral Infarction/Cerebral Embolism/Cerebral Thrombosis) --Stroke (Unspecified) --Pneumonia --COPD Exacerbation --Gastrointestinal Bleeding --Acute Renal Failure --Chronic Renal Failure --Dialysis (Hemodialysis/Peritoneal Dialysis) --Dyslipidemia --Hypertension --Diabetes Mellitus --Diabetic Nephropathy --Gastroesophageal Reflux --Oesophagismus --Cholelithiasis --Anemia --None of the Above Is Recorded
10 Summary of In-Hospital Events 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】
--Repeat/Recurrent Myocardial Infarction --Repeat/Recurrent Angina --Cardiac Rupture --Papillary Muscle Rupture --Ventricular Septal Perforation --Cardiac Tamponade --Pericardial Effusion --Cardiogenic Shock --Cardiac Arrest --Cardiopulmonary Resuscitation (CPR) --Atrial Fibrillation or Flutter --Ventricular Tachycardia/Ventricular Fibrillation --Acute Heart Failure --Exacerbation of Chronic Heart Failure --Infection --Acute Pulmonary Edema --Gastrointestinal Bleeding --Genitourinary Bleeding
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--Intracranial/Subdural Bleeding --Retroperitoneal Bleeding --Access Site Bleeding (Including Hematoma at Access Site) --Pericardial Bleeding --Bleeding (Unspecified) --Hemorrhagic Shock --Venous Thromboembolism --Pulmonary Embolism --Deep Vein Thrombosis --Stent Thrombosis --Significant Dissection --Perforation --Abrupt Vessel Closure in the Catheterization Laboratory --Side Branch Occlusion --Distal Embolization --No Flow/Slow Flow Phenomenon --Access Site Occlusion --Access Site Arteriovenous Fistula --Access Site Hematoma --Access Site Dissection --Ischemic Stroke (Cerebral Infarction/Thrombosis/Cerebral Embolism) --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Stroke (Unspecified) --Acute Renal Failure --Dialysis (Hemodialysis/Peritoneal Dialysis) --Contrast Reaction (Include Severe Allergic Reaction) --Contrast-Induced Nephropathy (CIN) --Thrombocytopenia
11 In- Hospital Implantation of Intra-Aortic Balloon Pump (IABP)【【【【SC】】】】 --Yes --No
12.1 Date of Implantation of Intra-Aortic Balloon Pump (IABP) _____【【【【C】】】】
12.2 Time of Implantation of Intra-Aortic Balloon Pump (IABP) _____【【【【F】】】】
13 Did the Patient Refuse the Following Treatments?
【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】 --Refused Percutaneous Coronary Intervention (PCI) --Refused Fibrinolysis --Refused CABG
14 Documented Reasons for Non-prescription of Aspirin in the First 24
Hours【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【【【【F】
15 Documented Reasons for Non-prescription of Beta-blocker in the First
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24 Hours【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
16 Documented Reasons for Non-prescription of Fibrinolysis in the First 24
Hours【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
17 Documented Reasons for Non-prescription of GP IIB/IIIA Inhibitors【【【【SC】】】】 --No --Allergy/Intolerance --Patient Refused --Fibrinolytics Given --Active or Recent (In Past 4 Weeks) Bleeding --Warfarin/Coumadin as Pre-Arrival Medication
--Other Reason Documented by Physician, Specify _____【F】
18 Documented Reasons for Non-prescription of Heparins【【【【SC】】】】 --No --Allergy
--Other (Specify) _____【F】
19 Documented Reasons for Non-prescription of Other Anti-Thrombin
Agents (e.g. Bivalirudin/Lepirudin/Argatroban)【【【【SC】】】】 --No --Allergy/Intolerance --Patient Refused --Stroke or Other Cerebrovascular Event in the Past Year --Known Intracranial Neoplasm --Active or Recent (Past 4 Weeks) Internal Bleeding --Suspected Aortic Dissection --Recent Surgery --Severe Uncontrolled Hypertension on Presentation --Pregnancy --Trauma
--Other Reasons (Specify) _____【F】
20 Documented Reasons for Non-prescription of Aspirin at Discharge【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
21 Documented Reasons for Non-prescription of ACE Inhibitor at Discharge
【【【【SC】】】】 --No --Yes--Allergy
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--Yes--Other (Specify) _____【F】
22 Documented Reasons for Non-prescription of ARB at Discharge【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
23 Documented Reasons for Non-prescription of Beta-blocker at Discharge【【【【SC】】】】
--No --Yes--Allergy
--Yes--Other (Specify) _____【F】
24 Documented Reasons for Non-prescription of Statin at Discharge【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
25 Discharge Status【【【【SC】】】】 --Discharge without Transfer to Another Hospital --Physician Recommends Transfer to Another Hospital --Patient or Relatives Demand Transfer to Another Hospital --Patient Left Against Medical Advice --None of the Above Is Recorded
26 Discharge Diagnosis (Related to Coronary Heart Disease)【【【【MC】】】】 --Coronary Heart Disease --Acute Coronary Syndrome --Acute Myocardial Infarction --Acute Extensive Anterior Myocardial Infarction --Acute Anterior Myocardial Infarction --Acute Septal Myocardial Infarction --Acute Inferior Myocardial Infarction --Acute Lateral Myocardial Infarction --Acute Posterior Myocardial Infarction --Acute Right Ventricular Myocardial Infarction --Acute Non ST-Elevation Myocardial Infarction --Acute ST-Elevation Myocardial Infarction --Subendocardial Myocardial Infarction --Acute Myocardial Infarction Suspected --Previous Q-Wave Myocardial Infarction --Unstable Angina Pectoris --Stable Angina Pectoris --Prinzmetal's Angina --Angina (Unrecorded Subtype) --Repeated/Recurrent Myocardial Infarction --Repeated/Recurrent Unstable Angina
27 Discharge Diagnosis of Acute Myocardial Infarction【【【【SC】】】】 --Yes—Answer the Questions Below Marked with an Asterisk (*)
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--No
28 Discharge Diagnosis【【【【MC】】】】 --Cardiac Rupture --Papillary Muscle Rupture --Ventricular Septal Perforation --Cardiac Tamponade --Pericardial Effusion --Cardiogenic Shock --Cardiac Arrest --Atrial Fibrillation --Ventricular Tachycardia/Ventricular Fibrillation --Acute Heart Failure --Chronic Heart Failure --Heart Failure (Unspecified) --Acute Pulmonary Edema --Gastrointestinal Bleeding --Genitourinary Bleeding --Intracranial/Subdural Bleeding --Retroperitoneal Bleeding --Access Site Bleeding (Including Hematoma at Access Site) --Pericardial Bleeding --Bleeding (Unspecified) --Hemorrhagic Shock --Venous Thromboembolism --Pulmonary Embolism --Deep Vein Thrombosis --Ischemic Stroke (Cerebral Infarction/Thrombosis/Cerebral Embolism) --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Stroke (Unspecified) --Pneumonia --Infection --COPD Exacerbation --Dyslipidemia --Hypertension --Diabetes Mellitus --Diabetic Nephropathy --Acute Renal Failure --Chronic Renal Failure --Dialysis (Hemodialysis/Peritoneal Dialysis) --Contrast Reaction (Include Severe Allergic Reaction) --Contrast-Induced Nephropathy (CIN) --Thrombocytopenia --Gastroesophageal Reflux --Oesophagismus --Cholelithiasis --Anemia --Unrecorded
29 Discharge Suggestions【【【【MC】】】】
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--Dual Anti-Platelet (Aspirin and Clopidogrel) Therapy【F】
--Regular Blood Lipid Assessment --Dietary Improvement --Weight Reduction --Smoking Cessation --Regular Exercise --PCI --CABG --None of the Above Is Recorded
30 Specify the Duration of Dual Anti-Platelet Therapy _____【【【【F】】】】
31 Medications at Discharge _____【【【【Drug Database(D)】】】】
32 Administration【【【【SC】】】】 --P.O. /Undefined --I.V. drip/ I.V. gtt (intravenously guttae) --I.V. --I.H. (Hypodermic Injection) --I.D. (intradermal Injection) --Others
Dose _____【【【【F】】】】
Unit【【【【SC】】】】 --g --mg --ml --u --piece/ # --mg/kg --mg/h --mg/min --mg/kg·h --ml/kg --ml/h --ml/min --ml/kg·min --u/kg --u/min --u/h --u/kg·h --ug --ug/kg --ug/min --ug/kg·min --MU --BU --% --Other
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--Unrecorded
Frequency【【【【SC】】】】 --Qd /QN --Bid/q12h --Tid/q8h --Q6h --As Needed
--Other --Unrecorded
【33-60】】】】Repeat Questions No.31 to 32 for the Other 14 Available Agents
Admission Records & History of Diseases
61.1 *Ischemic Symptoms Onset Date _____Days Ago【【【【F】】】】
61.2 *Ischemic Symptoms Onset Time _____Hours Ago【【【【F】】】】
62.1 *Ischemic Symptoms Onset Date _____【【【【C】】】】
62.2 *Ischemic Symptoms Onset Time _____【【【【F】】】】
63 *Was the Time of Ischemic Symptom Onset Estimated?【【【【SC】】】】 --Yes --No
64 *Did the Patient Have Chest Discomfort (Chest Pain/Chest Discomfort/Chest Pressure/Other Symptoms in Chest)?【【【【SC】】】】 --Yes --No --Unrecorded
65 *Did the Chest Discomfort Last 10 or More Minutes?【【【【SC】】】】 --Yes --No --Unrecorded
66 *Did the Patient Have Other Ischemia Symptoms (Shortness of
Breath/Pain at Non-chest Sites/Nausea/Vomit/Fatigue)?【【【【SC】】】】 --Yes --No --Unrecorded
67 *Did Other Ischemic Symptoms Last 10 or More Minutes?【【【【SC】】】】 --Yes --No --Unrecorded
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68 CAD Presentation【【【【MC】】】】 --No Symptoms, No Angina --Symptoms Unlikely to Be Ischemic --Stable Angina --Unstable Angina --Non-STEMI --STEMI
69 *Was Medical Assistance Provided at Outside Facilities Prior to This
Hospitalization?【【【【SC】】】】
--Yes --No --Unrecorded
70 *Treatment Prior to Arrival 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】 --Aspirin --Clopidogrel --Ticlopidine --Antiplatelet Therapy --Fibrinolysis (If Yes, Specify: SK, UK, Rt-PA, Other) --External Defibrillation --CPR/Chest Compression --Temporary Cardiac Pacing
71 Time of Arrival at Your Hospital_____【【【【F】】】】
72 Was Time of Arrival at Your Hospital Estimated?【【【【SC】】】】 --Yes --No --Unrecorded
73 Treatment in Emergency Room Prior to Admission 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】 --Aspirin --Clopidogrel --Ticlopidine --Antiplatelet Therapy --Fibrinolysis (If Yes, Specify: SK, UK, Rt-PA, Other) --External Defibrillation --CPR/Chest Compression --Temporary Cardiac Pacing
74 Cardiogenic Shock at Presentation【【【【SC】】】】 (Sustained (>30 minutes) Episode of Systolic Blood Pressure <90 mm Hg/Cardiac Index <2.2 L/min/m2/Requirement for Parenteral Inotropic or Vasopressor Agents/Mechanical Support [e.g. IABP/Extracorporeal Circulation/Ventricular Assist Devices]) --Yes
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--No --Unrecorded
75 Past Medical History (Related to Heart Disease) 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】
--Coronary Heart Disease --Angina Pectoris --Myocardial Infarction --Prior PCI --Prior CABG --Ventricular Tachycardia --Atrial Fibrillation/Flutter --Bradycardia --Heart Failure --Valvular Heart Disease
76 If Patient Had a Prior PCI, Most Recent PCI Date【【【【SC】】】】
--<1 Month Ago
--1-5 Months Ago --6-12 Months Ago -- 1-2 Years Ago
-->2 Years Ago
--Unrecorded
77 If Patient Had a Prior CABG, Most Recent CABG Date【【【【SC】】】】
--<1 Month Ago
--1-5 Months Ago --6-12 Months Ago -- 1-2 Years Ago
-->2 Years Ago
--Unrecorded
78.1 Specify the First Home Medication _____【【【【F】】】】
78.2 Specify the Second Home Medication _____【【【【F】】】】
78.3 Specify the Third Home Medication _____【【【【F】】】】
78.4 Specify the Fourth Home Medication _____【【【【F】】】】
78.5 Specify the Fifth Home Medication _____【【【【F】】】】
79 Features of the Heart Failure 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】
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--Unusual Dyspnea on Light Exertion --Recurrent Dyspnea Occurring in the Supine Position
80 Past Medical History (Unrelated to Heart Disease) 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】
--Hypertension --Diabetes Mellitus --Dyslipidemia --Peripheral Vascular Disease (Intermittent Claudication/Lower Limb Arterial Embolism) --Ischemic Stroke (Cerebral Embolism/Cerebral Infarction/Cerebral Thrombosis) --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Stroke (Unspecified) --Carotid Artery Surgery/Intervention --Chronic Lung Disease (COPD/Chronic Bronchitis/Emphysema/Asbestosis/Mesothelioma/ Black Lung Disease/Pneumoconiosis/Radiation-induced Pneumonitis/Radiation Fibrosis)
--Chronic Renal Failure --Currently on Dialysis --Hepatitis B --Hepatitis C --Cirrhosis --Family History of CAD
81 Drug Allergy _____【【【【F】】】】
Personal History
82 Smoking History【【【【SC】】】】 --Never --Past --Current --Unrecorded
83 If Current, Duration _____Years _____Months【【【【F】】】】
84 If Past, Duration _____Years _____Months【【【【F】】】】
85 Smoking Frequency _____Cigarettes/Day【【【【F】】】】
Physical Examination
86 Vital Signs【【【【F】】】】 --Temperature at Presentation to This Facility _____°C --Heart Rate at Presentation to This Facility _____bpm --Respiratory Rate at Presentation to This Facility _____bpm --Systolic Blood Pressure at Presentation to This Facility _____mmHg --Diastolic Blood Pressure at Presentation to This Facility _____mmHg
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87 Signs of Heart Failure【【【【MC】】】】
【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】 --Jugular Venous Distension --Rales --Pulmonary Edema --Fluid Retention (Lower Extremity Edema)
Auxiliary Examination
88 Was the ECG Performed at Hospital Presentation Available in Medical Record?【【【【
SC】】】】 --Yes --No
89.1 Date of First ECG at Hospital _____【【【【C】】】】
89.2 Time of First ECG at Hospital _____【【【【F】】】】
90 Original Interpretation of ECG【【【【MC】】】】 --Acute MI --Complete LBBB (Unspecified) --ST-Elevation --ST-Depression --Previous MI (Q Wave) --Ventricular Fibrillation --Ventricular Tachycardia --Atrial Fibrillation --2nd Degree Atrioventricular Block Type 1 --2nd Degree Atrioventricular Block Type 2 --3nd Degree Atrioventricular Block
91 Was a Second ECG Performed during Hospitalization Available in
Medical Record?【【【【SC】】】】 --Yes --No
92.1 Date of Second ECG at Hospital _____【【【【C】】】】
92.2 Time of Second ECG at Hospital _____【【【【F】】】】
93 Original Interpretation of ECG【【【【MC】】】】 --Acute MI --Complete LBBB (Unspecified) --ST-Elevation --ST-Depression --Previous MI (Q Wave) --Ventricular Fibrillation --Ventricular Tachycardia
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--Atrial Fibrillation --2nd Degree Atrioventricular Block Type 1 --2nd Degree Atrioventricular Block Type 2 --3nd Degree Atrioventricular Block
94 Was a Third ECG Performed during Hospitalization Available in Medical
Record?【【【【SC】】】】 --Yes --No
95.1 Date of Third ECG at Hospital _____【【【【C】】】】
95.2 Time of Third ECG at Hospital _____【【【【F】】】】
96 Original Interpretation of ECG【【【【MC】】】】 --Acute MI --Complete LBBB (Unspecified) --ST-Elevation --ST-Depression --Previous MI (Q Wave) --Ventricular Fibrillation --Ventricular Tachycardia --Atrial Fibrillation --2nd Degree Atrioventricular Block Type 1 --2nd Degree Atrioventricular Block Type 2 --3nd Degree Atrioventricular Block
97 Was CK Tested at the Prior Hospital or in the Emergency Room of Your
Hospital? 【【【【SC】】】】 --Yes --No
98.1 CK Value _____【【【【F】】】】
98.2 Unit of CK _____【【【【SC】】】】 --IU/L --ng/ml --mg/ml --% --mg/IU --ml/IU
98.3 CK Date _____【【【【C】】】】
98.4 CK Time_____【【【【F】】】】
99 Was CK-MB Tested at the Prior Hospital or in the Emergency Room of Your
Hospital? 【【【【SC】】】】 --Yes --No
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100.1 CK-MB Value _____【【【【F】】】】
100.2 Unit of CK-MB _____【【【【SC】】】】 --IU/L --ng/ml --mg/ml --% --mg/IU --ml/IU
100.3 CK-MB Date_____【【【【C】】】】
100.4 CK-MB Time_____【【【【F】】】】
101 Was Troponin Tested at the Prior Hospital or in the Emergency Room of
Your Hospital?【【【【SC】】】】 --Yes --No
102.1 Troponin Date _____【【【【C】】】】
102.2 Troponin Time_____【【【【F】】】】
103 The Type of Troponin 【【【【MC】】】】 --Troponin T --Troponin I --Troponin (Unspecified)
104 Value for Troponin T? 【【【【SC】】】】 --Positive --Negative --Numerical value
105 Troponin T Value _____ng/ml【【【【F】】】】
106 Value for Troponin I? --Positive --Negative --Numerical value
107 Troponin I Value _____ng/ml【【【【F】】】】
108 Value for Troponin (Unspecified)? --Positive --Negative --Numerical value
109 Troponin (Unspecified) Value _____ng/ml【【【【F】】】】
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110 Was Routine Blood Test Performed at the Prior Hospital or in the
Emergency Room of Your Hospital?【【【【SC】】】】 --Yes --No
111.1 White Blood Cell (WBC) Value _____ X 109【【【【F】】】】
111.2 Neutrophil Ratio _____ %【【【【F】】】】
111.3 Hemoglobin Value _____ g/L【【【【F】】】】
111.4 Platelet Count Value _____ x109【【【【F】】】】
111.5 Routine Blood Test Date _____【【【【C】】】】
112.1 Creatinine Value _____umol/L【【【【F】】】】
112.2 Date of Creatinine Test _____【【【【C】】】】 113 Was Coagulation Test Performed at the Prior Hospital or in the
Emergency Room of Your Hospital?【【【【SC】】】】 --Yes --No
114.1 PT Value _____s【【【【F】】】】
114.2 APTT Value _____s【【【【F】】】】
114.3 INR Value _____【【【【F】】】】
114.4 Coagulation Test Date _____【【【【C】】】】
Preliminary Diagnosis
115 Admission Diagnosis (Related to Coronary Heart Disease)【【【【MC】】】】Same As No.9
116 Admission Diagnosis (Unrelated to Coronary Heart Disease)【【【【MC】】】】Same As No.10
117 Killip Classification【【【【SC】】】】 --I --II --III --IV --Unrecorded
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118 NYHA Classification【【【【SC】】】】
--I --II --III --IV --Unrecorded
Daily Records
119 Are Daily Records Filed into This Medical Record?【【【【SC】】】】
--Yes --No
120 In-Hospital Events【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】
--Repeat/Recurrent Myocardial Infarction --Repeat/Recurrent Angina --Cardiac Rupture --Papillary Muscle Rupture --Ventricular Septal Perforation --Cardiac Tamponade --Pericardial Effusion --Cardiogenic Shock --Cardiac Arrest --Cardiopulmonary Resuscitation (CPR) --Atrial Fibrillation or Flutter --Ventricular Tachycardia/Ventricular Fibrillation --Acute Heart Failure --Exacerbation of Chronic Heart Failure --Infection --Acute Pulmonary Edema --Gastrointestinal Bleeding --Genitourinary Bleeding --Intracranial/Subdural Bleeding --Retroperitoneal Bleeding --Access Site Bleeding (Including Hematoma at Access Site) --Pericardial Bleeding --Bleeding (Unspecified) --Hemorrhagic Shock --Venous Thromboembolism --Pulmonary Embolism --Deep Vein Thrombosis --Stent Thrombosis --Significant Dissection --Perforation --Abrupt Vessel Closure in the Catheterization Laboratory --Side Branch Occlusion --Distal Embolization --No Flow/Slow Flow Phenomenon
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--Access Site Occlusion --Access Site Arteriovenous Fistula --Access Site Hematoma --Access Site Dissection --Ischemic Stroke (Cerebral Infarction/Thrombosis/Cerebral Embolism) --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Stroke (Unspecified) --Acute Renal Failure --Dialysis (Hemodialysis/Peritoneal Dialysis) --Contrast Reaction (Include Severe Allergic Reaction) --Contrast-Induced Nephropathy (CIN) --Thrombocytopenia
121 Did the Patient Refuse the Following Treatment? 【【【【Every Item Has Three Options—Y/N/Unrecorded】】】】
--Refused Percutaneous Coronary Intervention (PCI) --Refused Fibrinolysis --Refused CABG
122 Cardiac Arrest Date _____【【【【C】】】】
123 Stroke Date _____【【【【C】】】】
124 Bleeding Date _____【【【【C】】】】
125 Interventions for Management of Bleeding【【【【MC】】】】
--Local Compression --Surgery --Endoscopic --Transfusion --Others --None --Unrecorded
126 The Nadir Blood Pressure After Bleeding Event (Lowest Recorded BP On the Day of and the Next Day After Bleeding Onset) _____/_____mm
Hg【【【【F】】】】
127 Hospital-Acquired Infection Site【【【【SC】】】】
--Pulmonary --Genitourinary --Gastrointestinal --Skin --Surgical site/Access site
--Other, Specify _____【F】
--Unrecorded
128 In-Hospital Implantation of Intra-Aortic Balloon Pump (IABP) 【【【【SC】】】】
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--Yes --No --Unrecorded
129.1 Implantation of Intra-Aortic Balloon Pump (IABP) Date _____【【【【C】】】】
129.2 Implantation of Intra-Aortic Balloon Pump (IABP) Time_____【【【【F】】】】
130 The First Coronary Angiography Status【【【【SC】】】】
--Elective --Urgent --Emergency --Salvage --Unrecorded
131 The First PCI Status【【【【SC】】】】
--Elective --Urgent --Emergency --Salvage --Unrecorded
132 The Second Coronary Angiography Status【【【【SC】】】】
--Elective --Urgent --Emergency --Salvage --Unrecorded
133 The Second PCI Status【【【【SC】】】】
--Elective --Urgent --Emergency --Salvage --Unrecorded
134 Reasons for Repeat PCI During Hospitalization【【【【SC】】】】
--No Repeat PCI --Staged Procedure --Ongoing or recurrent ischemia --Other --Unrecorded
135 Documented Reasons for Non-prescription of Aspirin in the First 24 Hour【【【【SC】】】】 --No --Yes--Allergy
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--Yes--Other (Specify) _____【F】
136 Documented Reasons for Non-prescription of Beta-blocker in the First 24 Hours【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
137 Documented Reasons for Non-prescription of Fibrinolytics in the First 24 Hours【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) ______【F】
138 Documented Reasons for Non-prescription of GP IIB/IIIA Inhibitor【【【【SC】】】】 --No --Allergy/Intolerance --Patient Refused --Fibrinolytics Given --Active or Recent (In Past 4 Weeks) Bleeding --Warfarin/Coumadin as Pre-Arrival Medication
--Other Reason Documented by Physician, Specify _____【【【【F】
139 Documented Reasons for Non-prescription of Heparins【【【【SC】】】】 --No --Allergy
--Other (Specify) _____【【【【F】
140 Documented Reasons for Non-prescription of other Anti-Thrombin Agents (e.g. Bivalirudin/Lepirudin/Argatroban)【【【【SC】】】】 --Allergy/Intolerance --Patient Refused --Stroke or Other Cerebrovascular Event in the Past Year --Known Intracranial Neoplasm --Active or Recent (Past 4 Weeks) Internal Bleeding --Suspected Aortic Dissection --Recent Surgery --Severe Uncontrolled Hypertension on Presentation --Pregnancy --Trauma
--Other Reason (Specify) _____【F】
141 Documented Reasons for Non-prescription of Aspirin at Discharge【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
142 Documented Reasons for Non-prescription of ACE Inhibitor at Discharge【【【【SC】】】】
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--No --Yes--Allergy
--Yes--Other (Specify) _____【F】
143 Documented Reasons for Non-prescription of ARB at Discharge【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
144 Documented Reasons for Non-prescription of Beta-blocker at Discharge
【【【【SC】】】】
--No --Yes--Allergy
--Yes--Other (Specify) _____【F】
145 Documented Reasons for Non-prescription of Statin at Discharge【【【【SC】】】】 --No --Yes--Allergy
--Yes--Other (Specify) _____【F】
In-Hospital Device Placement
146 ICD【【【【SC】】】】
--Yes --No
147 ICD Date _____【【【【C】】】】
148 IABP【【【【SC】】】】 --Yes --No
149.1 IABP Date _____【【【【C】】】】
149.2 IABP Time _____【【【【F】】】】
Coronary Angiography and PCI Report
150 Diagnostic Catheterization or Diagnostic Coronary Angiography【【【【SC】】】】
--Yes --No
151.1 Procedure Start Date_____【【【【C】】】】
151.2 Procedure Start Time_____【【【【F】】】】
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152 Arterial Access Site【【【【SC】】】】
--Femoral Artery --Radial Artery --Brachial Artery --Other
153 Arterial Dominance【【【【SC】】】】
--Left Coronary Artery --Right Coronary Artery --Co-dominant --Unrecorded
154 If the Patient Has Not Had a CABG, Is Percent Stenosis Available in Each
of the Native Vessels?【【【【MC】】】】 --Left Main Artery (LM) --Proximal LAD --Mid/Distal LAD/Diag Branches --Circ/OMs/LPDA and LPL Branches --Ramus --RCA/RPDA/RPL/AM Branches --None of the Above is Recorded
155 LM Stenosis Percent _____【【【【F】】】】
156 Proximal LAD Stenosis Percent _____【【【【F】】】】
157 Mid/Distal LAD/Diagonal Stenosis Percent _____【【【【F】】】】
158 Circ/OMs/LPDA/LPL Stenosis Percent _____【【【【F】】】】
159 RCA/PRDA/RPL/AM Stenosis Percent _____【【【【F】】】】
160 Ramus Stenosis Percent _____【【【【F】】】】
161 Graft Vessel(s) Used for Previous CABG 【【【【MC】】】】
--LIMA --RIMA --Radial Artery --SVG --Unrecorded --No CABG History
162 Graft Percent Stenosis【【【【F】】】】
--Graft to Proximal LAD --Graft to Mid/Distal LAD/Diag Branches --Graft to Circ/OMs/LPDA and LPL Branches --Graft to RCA/RPDA/RPL/AM Branches
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--Graft to Ramus --LIMA --RIMA --SVG
163 Intravascular Ultrasound (IVUS ) Performed during the Procedure?【【【【SC】】】】
--Yes --No
164 Left Main Stem Protected?【【【【SC】】】】
--Yes --No
165 Mechanical Ventricular Support【【【【SC】】】】
--None --IABP --ECMO --LVAD
166 If Yes, Timing for IABP Implantation【【【【SC】】】】 --In Place at Start of Procedure --Inserted During Procedure and Prior to PCI --Inserted After PCI has Begun
167 If Yes, Timing for ECMO or LVAD Implantation【【【【SC】】】】 --In Place at Start of Procedure --Inserted During Procedure and Prior to PCI --Inserted After PCI has Begun
168 Recommendation (After Diagnostic Cath)【【【【MC】】】】 --None --Medical Therapy/Counseling --PCI without Planned CABG --CABG (Including Planned Hybrid Procedures) --Other Cardiac Therapy without CABG or PCI
169 Was PCI Performed Immediately Following Diagnostic Catheterization
【【【【SC】】】】
--Yes --No
170.1 PCI Date _____【【【【C】】】】
170.2 PCI Start Time _____【【【【F】】】】
171 Arterial Access Site【【【【SC】】】】
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--Femoral Artery --Radial Artery --Brachial Artery --Other
172 Cardiogenic Shock at Start of PCI【【【【SC】】】】
--Yes --No
173.1 Systolic Blood Pressure Prior to PCI _____mmHg【【【【F】】】】
173.2 Dilated Blood Pressure Prior to PCI _____mmHg【【【【F】】】】
173.3 Heart Rate Prior to PCI _____bpm【【【【F】】】】
174 Time of the First Treatment of Lesion (AngioJet/Other Thrombectomy/Aspiration Device/Laser/Rotational Atherectomy)
_____【【【【F】】】】
175 Time of the First Balloon Inflation _____【【【【F】】】】
176 Lesion Counter _____【【【【F】】】】
177 Choose Segments Below in Which Lesion is Located【【【【MC】】】】 --Left Main Artery (LM) --Proximal LAD --Mid/Distal LAD/Diag Branches --Circ/OMs/LPDA and LPL Branches --Ramus --RCA/RPDA/RPL/AM Branches
178 Stenosis Immediately Prior to PCI _____%【【【【F】】】】
179 Fractional Flow Reserve Ratio Measured during the Procedure _____【【【【F】】】】
180 Pre-Procedure TIMI Flow (Lowest TIMI Flow within the Entire Lesion)【【【【SC】】】】 --TIMI-0 --TIMI-1 --TIMI-2 --TIMI-3 --Unrecorded
181 Pre-treated Lesion【【【【SC】】】】
--Yes --No
182 If Yes, Treated with Stent【SC】
--Yes
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--No
183 If Yes, Reasons for PCI at Site of Former Stent【【【【SC】】】】 --In-stent Restenosis --In-stent Thrombosis --Unrecorded
184 Was Lesion in Bypass Graft【【【【SC】】】】
--Not in Graft --Vein --LIMA --Other Artery --Unrecorded
185 If Vein, LIMA, Other, Location in Graft【【【【SC】】】】
--Aortic (Proximal Vessel) --Body (Mid Vessel) --Distal --Unrecorded
186 Lesion Length ______mm【【【【F】】】】
187 The Characteristics of the Lesion【【【【MC】】】】 --Thrombus Present in the Lesion --Bifurcation Lesion --Calcified Lesion --Type A Lesion --Type B Lesion --Type C Lesion --None of the Above Is Recorded
188 Did Guidewire Cross the Lesion?【【【【SC】】】】
--Yes --No
189 Time Guidewire Crossed the Lesion _____【【【【F】】】】
190 Was a Stent Placed【【【【SC】】】】 --Yes --No
191 If Yes, Time Stent Deployment _____【【【【F】】】】
192.1 The First Stent’s Trade Name _____【【【【D】】】】
192.2 The Second Stent’s Trade Name _____【【【【D】】】】
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192.3 The Third Stent’s Trade Name _____【【【【D】】】】
193.1 The First Stent’s Diameter _____【【【【F】】】】
193.2 The First Stent’s Length _____【【【【F】】】】
193.3 The Second Stent’s Diameter _____【【【【F】】】】
193.4 The Second Stent’s Length _____【【【【F】】】】
193.5 The Third Stent’s Diameter _____【【【【F】】】】
193.6 The Third Stent’s Length _____【【【【F】】】】
194 Post-Procedural Percent Stenosis for the Treated Lesion _____%【【【【F】】】】
195 Post-Procedure TIMI Flow (Coded the Lowest TIMI Flow within the Entire Lesion【【【【SC】】】】
--TIMI-0 --TIMI-1 --TIMI-2 --TIMI-3 --Unrecorded
【196-275】Repeat Question 176 to 195 for Another 4 Lesions】
276 Were Any of the Following Devices Used?【【【【SC】】】】
--None --Balloon --Cutting Balloon --Rotablator --Aspiration Catheters --IVUS --Pressure Wire --Flowire --Brachytherapy --Distal/Proximal Embolic Protection --Thrombectomy Device
277 Was Left Ventricular Ejection Fraction Measured during the Procedure
【【【【SC】】】】
--Yes, EF=______% 【F】
--No
278 Type of Contrast Dye Used【【【【SC】】】】
--Lopamidol --Lopromide --Lohexol
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--Lodixanol --Lomeprol --Loversol --Other --Unrecorded
279 Total Volume of Contrast Dye Used _____ml【【【【F】】】】
280 Closure Method【【【【SC】】】】
--Seal (Angioseal/Vasoseal) --Suture --Manual Compression --Other Method --Unrecorded
281 PCI Complications【【【【MC】】】】
--Ventricular Tachycardia (VT) or Ventricular Fibrillation (V-Fib) --Significant Dissection --Perforation --Abrupt Vessel Closure in the Catheterization Laboratory --Side Branch Occlusion --Peripheral Embolization --Distal Embolization --No Flow/Slow Flow Phenomenon --Access Site Occlusion --Access Site Arteriovenous Fistula --Access Site Hematoma --Access Site Dissection --Access Complication Requiring Surgery/Intervention --None of the Above
【【【【282-414】】】】Repeat Question 150 to 281 for a Second Coronary Angiogram and/or PCI
CABG Report
415 CABG during Hospitalization?【【【【SC】】】】
--Yes --No
416 CABG Date _____【【【【C】】】】
Imaging Examination
417 Was Chest X-ray or Other Lung Imaging (Chest CT/MRI) Performed?【【【【SC】】】】
--Yes
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--No
418 Was Echocardiography Performed?【【【【SC】】】】
--Yes --No
419 Echocardiography LVEF Value _____%【【【【F】】】】
420 Was a Stress Test Performed?【【【【SC】】】】 --Yes --No
421.1 Stress Test Type【【【【SC】】】】
--ECG Only --Radionuclide --Echocardiography --Cardiac MRI --Unrecorded
421.2 Method of Stress Test【【【【SC】】】】
--Exercise --Pharmacologic --Unrecorded
422 Results of Stress Test【【【【SC】】】】
--Negative --Positive --Indeterminate --Unrecorded
423 Was a Coronary CT Angiogram Performed?【【【【SC】】】】
--Yes --No
424 Coronary Calcium Score _____【F】
In-Hospital ECG
425 Was the ECG Performed at Hospital Presentation Available in Medical
Record?【【【【SC】】】】 --Yes --No
426 Original Interpretation of ECG【【【【MC】】】】
--Acute MI
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--New Complete LBBB --Old Complete LBBB --Complete LBBB (Unspecified) --ST-Elevation --ST-Depression --Previous MI (Q Wave) --Ventricular Fibrillation --Ventricular Tachycardia --Atrial Fibrillation --2nd Degree Atrioventricular Block Type 1 --2nd Degree Atrioventricular Block Type 2 --3nd Degree Atrioventricular Block
Temperature Report
0.1 Admission Date _____【【【【C】】】】
0.2 Admission Time _____【【【【F】】】】
Discharge Date _____【【【【C】】】】
Height _____cm【【【【F】】】】
Admission Weight _____kg【【【【F】】】】
Long-term Physician Orders
Name of Long-term Medications _____【【【【D】】】】
Start Time _____【【【【F】】】】
Administration【SC】
--P.O. /Undefined --I.V. drip/ I.V. gtt (intravenously guttae) --I.V. --I.H. (Hypodermic Injection) --I.D. (Intradermal Injection) --Others
Dose _____【【【【F】】】】
Unit _____【【【【SC】】】】 --g --mg --ml --U --piece/ # --mg/kg
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--mg/h --mg/min --mg/kg·h --ml/kg --ml/h --ml/min --ml/kg·min --U/kg --U/min --U/h --U/kg·h --ug --ug/kg --ug/min --ug/kg·min --MU --BU --Other --Unrecorded
Frequency【SC】
--Qd /QN --Bid/q12h --Tid/q8h --Q6h --As Needed --Others --Unrecorded
End Date and Time_____【F】
【【【【434-591】】】】Repeat Questions No.432 to 433 for the Other 79 Available Agents
Short-term Physician Orders
592 Name of Short-term Medications ______【【【【D】】】】
593 Start Time______【【【【F】】】】
Administration【SC】
--P.O. /Undefined --I.V. drip/ I.V. gtt (intravenously guttae) --I.V. --I.H. (hypodermic injection) --I.D. (intradermal injection) --Others
Dose _____【【【【F】】】】
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Unit _____【【【【SC】】】】 --g --mg --ml --U --Piece/ # --mg/kg --mg/h --mg/min --mg/kg·h --ml/kg --ml/h --ml/min --ml/kg·min --U/kg --U/min --U/h --U/kg·h --ug --ug/kg --ug/min --ug/kg·min --MU --BU --Other --Unrecorded
Frequency【SC】
--Qd /QN --Bid/q12h --Tid/q8h --Q6h --As Needed --Others --Unrecorded
【594-791】】】】Repeat Questions No.592 to 593 for the other 99 Available Agents
Discharge Medications
792 Discharge Agent _____【【【【D】】】】
793 Administration【SC】
--I.V. drip/ I.V. gtt (intravenously guttae) --I.V. --I.H. (hypodermic injection) --I.D. (intradermal injection) --Others
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Dose _____【【【【F】】】】
Unit _____【【【【SC】】】】 --g --mg --ml --U --Piece/ # --mg/kg --mg/h --mg/min --mg/kg·h --ml/kg --ml/h --ml/min --ml/kg·min --U/kg --U/min --U/h --U/kg·h --ug --ug/kg --ug/min --ug/kg·min --MU --BU --Other --Unrecorded
Frequency【SC】
--Qd /QN --Bid/q12h --Tid/q8h --Q6h --As Needed --Others --Unrecorded
【【【【794-821】】】】Repeat Questions No.792 to 793 for the other 79 Available Agents
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY CASE REPORT FORM, PART 2
Contents The Face Sheet of Medical Records ........................................................................ 43 Lab Test ................................................................................................................... 49
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1 Study ID _____【【【【Free Text (F)】】】】
The Face Sheet of Medical Records
2 Medical Record Number _____【【【【F】】】】
3 Medical Insurance【【【【Single Choice (SC)】】】】
--Payment Out-of-Pocket --Free Medical Care --Urban Residents/Worker Medical Insurance --Comprehensive Arrangement for Serious Disease --New-Type Rural Cooperative Medical System (CMS) --Poverty Assistance Insurance --Commercial Medical Insurance --Other Social Insurance --Unrecorded
4 Gender【【【【SC】】】】
--Male --Female
5 Age _____【F】
6 Marital Status【【【【SC】】】】 --Married --Single --Divorced --Widowed --Unrecorded
7 Occupation【【【【SC】】】】
--Retired --Worker (Industrial/Mining/Construction/Other Similar Type of Work) --Farmer --Office work --Cadre --Teacher --Student --Physician --Businessman --Engineer --Policeman or Soldier --Freelancers --Unemployed --Other --Unrecorded
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8 Ethnicity【【【【SC】】】】
--Han --Zhuang --Man --Hui --Miao --Weiwuer --Tujia --Yi --Menggu --Zang --Buyi --Other --Unrecorded
9 Nationality【【【【SC】】】】
--China --Other --Unrecorded
10 Location of Residence【【【【SC】】】】
--Urban --Rural --Overseas --Unrecorded
11 Postal Code of Residence _____【【【【F】】】】
12 Admission Date _____【【【【C】】】】
13 Admission Time _____【【【【F】】】】
14 Discharge Date _____【【【【C】】】】
15 Department of Admission【【【【SC】】】】 --Cardiovascular Department --Internal Medicine Department --Geriatrics --Cadre's Ward --Intensive Care Unit (ICU) --Coronary Care Unit (CCU) --Other --Unrecorded
16 Was Patient Transferred from One Department to Another?【【【【SC】】】】
--Yes
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--No --Unrecorded
17 Discharge Department【【【【SC】】】】
--Cardiovascular Department --Internal Medicine Department --Geriatrics --Cadre's Ward --Intensive Care Unit (ICU) --Coronary Care Unit (CCU) --Other --Unrecorded
18 Date Diagnosis Was Confirmed _____【【【【C】】】】 19 Admission Diagnoses (Related to Coronary Heart Disease)
【【【【Multiple Choices Permitted (MC)】】】】 --Coronary Heart Disease --Acute Coronary Syndrome --Acute Myocardial Infarction --Acute Extensive Anterior Myocardial Infarction --Acute Anterior Myocardial Infarction --Acute Septal Myocardial Infarction --Acute Inferior Myocardial Infarction --Acute Lateral Myocardial Infarction --Acute Posterior Myocardial Infarction --Acute Right Ventricular Myocardial Infarction --Acute Non ST-Elevation Myocardial Infarction --Acute ST-Elevation Myocardial Infarction --Subendocardial Myocardial Infarction --Acute Myocardial Infarction Suspected --Previous Q-wave Myocardial Infarction --Unstable Angina Pectoris --Stable Angina Pectoris --Prinzmetal's Angina --Angina (Unrecorded Subtype) --None of the Above is Recorded
20 Admission Diagnoses (Unrelated to Coronary Heart Disease)【【【【MC】】】】
--Cardiac Arrest --Cardiogenic Shock --Ventricular Fibrillation/Ventricular Tachycardia --Atrial Fibrillation --Acute Heart Failure --Chronic Heart Failure --Heart Failure (Unspecified) --Acute Pulmonary Edema --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Ischemic Stroke (Cerebral Infarction/Cerebral Embolism/Cerebral Thrombosis)
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--Stroke (Unspecified) --Pneumonia --COPD Exacerbation --Gastrointestinal Bleeding --Acute Renal Failure --Chronic Renal Failure --Dialysis (Hemodialysis/Peritoneal Dialysis) --Dyslipidemia --Hypertension --Diabetes Mellitus --Gastroesophageal Reflux --Oesophagismus --Cholelithiasis --Anemia
21 Discharge Diagnoses【【【【MC】】】】
--Coronary Heart Disease --Acute Coronary Syndrome --Acute Myocardial Infarction --Acute Extensive Anterior Myocardial Infarction --Acute Anterior Myocardial Infarction --Acute Septal Myocardial Infarction --Acute Inferior Myocardial Infarction --Acute Lateral Myocardial Infarction --Acute Posterior Myocardial Infarction --Acute Right Ventricular Myocardial Infarction --Acute Non ST-Elevation Myocardial Infarction --Acute ST-Elevation Myocardial Infarction --Subendocardial Myocardial Infarction --Acute Myocardial Infarction Suspected --Previous Q-Wave Myocardial Infarction --Unstable Angina Pectoris --Stable Angina Pectoris --Prinzmetal's Angina --Angina (Unrecorded Subtype) --Repeated/Recurrent Myocardial Infarction --Repeated/Recurrent Unstable Angina --Cardiac Rupture --Papillary Muscle Rupture --Ventricular Septum Perforation --Cardiac Tamponade --Pericardial Effusion --Cardiogenic Shock --Cardiac Arrest --Atrial Fibrillation --Ventricular Tachycardia/Ventricular Fibrillation --Acute Heart Failure --Chronic Heart Failure --Heart Failure (Unspecified) --Acute Pulmonary Edema
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--Gastrointestinal Bleeding --Genitourinary Bleeding --Intracranial/Subdural Bleeding --Retroperitoneal Bleeding --Access Site Bleeding (Including Hematoma at Access Site) --Pericardial Bleeding --Bleeding (Unspecified) --Hemorrhagic Shock --Venous Thromboembolism --Pulmonary Embolism --Deep Vein Thrombosis --Ischemic Stroke (Cerebral Infarction/Thrombosis/Cerebral Embolism) --Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage) --Stroke (Unspecified) --Pneumonia --Infection --COPD Exacerbation --Dyslipidemia --Hypertension --Diabetes Mellitus --Diabetic Nephropathy --Acute Renal Failure --Chronic Renal Failure --Dialysis (Hemodialysis/Peritoneal Dialysis) --Contrast Reaction (Include Severe Allergic Reaction) --Contrast-Induced Nephropathy (CIN) --Thrombocytopenia --Gastroesophageal Reflux --Oesophagismus --Cholelithiasis --Anemia
22 ICD (for Every Diagnosis)【【【【SC】】】】
--ICD 9 --ICD 10 --Unrecorded
23 ICD9 (Specify) _____【【【【F】】】】
24 ICD10 (Specify) _____【【【【F】】】】
25 Nosocomial Infection (Specify) _____【【【【F】】】】
26 Drug Allergy (Specify) _____【【【【F】】】】
27 HBs-Ag【【【【SC】】】】 --Untested --Negative --Positive
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28 HCV-Ab【【【【SC】】】】
--Untested --Negative --Positive
29 HIV-Ab【【【【SC】】】】
--Untested --Negative --Positive
30 The First Procedure Date______【【【【F】】】】
31 Procedures Performed During Hospitalization【【【【MC】】】】 --PCI --CAG --PCI+CAG --PTCA --CABG --LVAD --IABP --ICD --Cardiac Resynchronization Therapy --CRT-D --Pacemaker
--Other (Specify) ______【F】
32 The Second Procedure Date _____【【【【F】】】】
33 Procedures Performed during Hospitalization【【【【MC】】】】 --PCI --CAG --PCI+CAG --PTCA --CABG --LVAD --IABP --ICD --Cardiac Resynchronization Therapy --CRT-D --Pacemaker
--Other (Specify) ______【F】
34 Gross Charge _____ Yuan【【【【F】】】】
35 Autopsy【【【【SC】】】】
--Yes
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--No --Unrecorded
36 The Type of Blood Transfusion【【【【MC】】】】
--No Blood Transfusion --Red Blood Cell --Platelet --Blood Plasma --Whole Blood
--Other (Specify)______【F】
Lab Test
37 Unit of Myohemoglobin【【【【SC】】】】
--IU/L --ng/ml --mg/ml --Other
38 Myohemoglobin Upper Limit of Normal (ULN) _____【【【【F】】】】
39 Initial Myohemoglobin Value _____【【【【F】】】】
40 Initial Myohemoglobin Date and Time _____【【【【C】】】】
41 Maximum Myohemoglobin _____【【【【F】】】】
42 Maximum Myohemoglobin Date and Time _____【【【【C】】】】
43 Unit of Creatine Kinase (CK) Level【【【【SC】】】】 --IU/L --ng/ml --mg/ml --% --mg/IU --ml/IU
44 Initial CK Upper Limit of Normal (ULN) _____【【【【F】】】】
45 Initial Creatine Kinase (CK) Value _____【【【【F】】】】
46 Initial Creatine Kinase (CK) Date and Time _____【【【【C】】】】
47 Maximum Creatine Kinase (CK) Value _____【【【【F】】】】
48 Maximum Creatine Kinase (CK) Date and Time _____【【【【C】】】】
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49 Unit of Creatine Kinase (CK-MB) Level【【【【SC】】】】 --IU/L --ng/ml --mg/ml --% --mg/IU --ml/IU
50 Initial CK-MB Upper Limit of Normal (ULN) _____【【【【F】】】】
51 Initial CK-MB Value _____【【【【F】】】】
52 Initial CK-MB Date and Time _____【【【【F】】】】
53 Maximum CK-MB Value _____【【【【F】】】】
54 Maximum CK-MB Date and Time _____【【【【C】】】】
55 Unit of Troponin I【【【【SC】】】】 --ng/ml --IU/L or U /L --Other
56 Initial Troponin I Value【【【【SC】】】】
--Positive --Negative
--Trace(+/-)
--Numerical Value______【F】
57 Initial Troponin I Upper Reference Limit (URL) _____【【【【F】】】】
58 Initial Troponin I Value _____【【【【F】】】】
59 Initial Troponin I Date and Time _____【【【【C】】】】
60 Maximum Troponin I Value _____【【【【F】】】】
61 Maximum Troponin I Date and Time _____【【【【C】】】】
62 Unit of Troponin T【【【【SC】】】】
--ng/ml --IU/L or U /L --Other
63 Initial Troponin T Value【【【【SC】】】】
--Positive --Negative
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--Numerical Value
64 Initial Troponin T Upper Reference Limit (URL) _____【【【【F】】】】
65 Initial Troponin T Value _____【【【【F】】】】
66 Initial Troponin T Date and Time _____【【【【C】】】】
67 Maximum Troponin T Value _____【【【【F】】】】
68 Maximum Troponin T Date and Time _____【【【【C】】】】
69 Unit of Troponin (Unspecified) 【【【【SC】】】】 --ng/ml --IU/L or U /L --Other
70 Initial Troponin (Unspecified) Value【【【【SC】】】】
--Positive --Negative --Numerical Value
71 Initial Troponin (Unspecified) Upper Reference Limit (URL) _____【【【【F】】】】
72 Initial Troponin (Unspecified) Value _____【【【【F】】】】
73 Initial Troponin (Unspecified) Date and Time _____【【【【C】】】】
74 Maximum Troponin (Unspecified) value _____【【【【F】】】】
75 Maximum Troponin (Unspecified) Date and Time _____【【【【C】】】】
76 First White Blood Cell (WBC) Value ______ X109【【【【F】】】】
77 Date and Time ______【【【【C】】】】
78 Initial Neutrophil Ratio _____ %【【【【F】】】】
79 Date and Time _____【【【【C】】】】
80 Initial Hemoglobin Value _____ g/L【【【【F】】】】
81 Date and Time _____【【【【C】】】】
82 Initial Platelet Count Value _____ x109【【【【F】】】】
83 Date and Time _____【【【【C】】】】
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84 Initial HCT Value _____【【【【F】】】】
85 Date and Time_____【【【【C】】】】
86 Minimum Platelet Count Value _____x109【【【【F】】】】
87 Date and Time _____【【【【C】】】】
88 Lowest Recorded Hemoglobin Value _____g/L【【【【F】】】】
89 Date and Time _____【【【【C】】】】
90 Last Hemoglobin Value _____g/L【【【【F】】】】
91 Date and Time _____【【【【C】】】】
92 Minimum HCT Value _____【【【【F】】】】
93 Date and Time _____【【【【C】】】】
94 Last HCT Value _____【【【【F】】】】
95 Date and Time _____【【【【F】】】】
96 Initial Urine Routine Date and Time _____【【【【C】】】】
97 Urine Protein【【【【SC】】】】 --Negative --Positive/+
--Trace(+/-)
--++ --+++ --++++
98 Initial LDH value _____(U/L;IU/L)【【【【F】】】】
99 Date and Time _____【【【【C】】】】 100 Units of Glucose
--mg/ml --mmol/L --Other
101 Initial GLU Value _____【【【【F】】】】
102 Glycosylated Hemoglobin (HbA1c) _____%【【【【F】】】】
103 Initial ALT Value _____U/L【【【【F】】】】
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104 Date and Time _____【【【【C】】】】
105 Initial AST Value _____U/L【【【【F】】】】
106 Date and Time _____【【【【C】】】】
107 Maximum ALT _____U/L【【【【F】】】】
108 Date and Time _____【【【【C】】】】
109 Maximum AST _____U/L【【【【F】】】】
110 Date and Time _____【【【【C】】】】
111 Lowest ALT _____U/L【【【【F】】】】
112 Date and Time _____【【【【C】】】】
113 Lowest AST _____U/L【【【【F】】】】
114 Date and Time_____【【【【C】】】】
115 Initial Total Bilirubin Value _____umol/L【【【【F】】】】
116 Date and Time _____【【【【C】】】】
117 Initial Direct Bilirubin Value _____ umol/L【【【【F】】】】
118 Date and Time _____【【【【C】】】】
119 Units of Creatinine【【【【SC】】】】 --mg/dL --Mmol/L --Other
120 Initial Creatinine Value _____【【【【F】】】】
121 Date and Time _____【【【【C】】】】
122 Maximum Creatinine Value _____【【【【F】】】】
123 Date and Time _____【【【【C】】】】
124 Last Creatinine Value _____【【【【F】】】】
125 Date and Time _____【【【【C】】】】
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126 Units of BUN【【【【SC】】】】 --mg/dL --Mmol/L --Other
127 Initial BUN Value _____【【【【F】】】】
128 Date and Time _____【【【【C】】】】
129 Maximum BUN Value _____【【【【F】】】】
130 Date and Time _____【【【【C】】】】
131 Units of Lipid【【【【SC】】】】
--mg/dl --Mmol/L --Other
132 Initial Lipid Date and Time _____【【【【C】】】】
133 Total Cholesterol Value _____【【【【F】】】】
134 HDL Cholesterol Value _____【【【【F】】】】
135 LDL Cholesterol Value _____【【【【F】】】】
136 Triglycerides Value _____【【【【F】】】】
137 Initial Potassium Value _____ (mEq/L; mmol/L)【【【【F】】】】
138 Date and Time _____【【【【C】】】】
139 Last Potassium Value _____(mEq/L; mmol/L)【【【【F】】】】
140 Date and Time _____【【【【C】】】】
141 Units of BNP/NT-pBNP【【【【SC】】】】 --pg//ml --ug/L --ug//ml --Fmol/L --Other
142 Initial BNP Value _____【【【【F】】】】
143 Date and Time _____【【【【C】】】】
144 Initial NT-pBNP Value _____【【【【F】】】】
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145 Date and Time _____【【【【C】】】】
146 Units of CRP【【【【SC】】】】 --mg/L --pg//ml --Other
147 Initial CRP Value _____【【【【F】】】】
148 Units of HsCRP【【【【SC】】】】 --mg/L --pg//ml --Other
149 Initial HsCRP Value _____【【【【F】】】】
150 Initial Coagulation Examination Date and Time _____【【【【C】】】】
151 INR Value _____【【【【F】】】】
152 APTT Value _____ s【【【【F】】】】
153 PT Value _____s【【【【F】】】】
154 The Second Coagulation Examination Date and Time _____【【【【C】】】】
155 INR Value _____【【【【F】】】】
156 APTT Value _____s【【【【F】】】】
157 PT Value _____s【【【【F】】】】
158 The Third Coagulation Examination Date and Time _____【【【【C】】】】
159 INR Value _____【【【【F】】】】
160 APTT Value _____s【【【【F】】】】
161 PT Value _____s【【【【F】】】】
162 The Fourth Coagulation Examination Date and Time _____【【【【C】】】】
163 INR Value _____【【【【F】】】】
164 APTT Value _____s【【【【F】】】】
165 Initial PT Value _____ s【【【【F】】】】
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166 The Fifth Coagulation Examination Date and Time _____【【【【C】】】】
167 INR Value _____【【【【F】】】】
168 APTT Value _____s【【【【F】】】】
169 Initial PT Value _____ s【【【【F】】】】
170 The Sixth Coagulation Examination Date and Time _____【【【【C】】】】
171 INR Value _____【【【【F】】】】
172 APTT Value _____s【【【【F】】】】
173 Initial PT Value _____s【【【【F】】】】
174 HBsAg【【【【SC】】】】 --Positive --Negative
--Numerical Value _____【【【【F】】】】
175 HBsAg Upper Reference Limit (URL) _____【【【【F】】】】
176 Anti-HBs/HBs-Ab【【【【SC】】】】 --Positive
--Negative
--Numerical Value _____【【【【F】】】】
177 Anti-HBs/HBs-Ab Upper Reference Limit (URL) _____【【【【F】】】】
178 HBeAg【【【【SC】】】】 --Positive --Negative
--Numerical Value _____【【【【F】】】】
179 HBeAg Upper Reference Limit (URL) _____【【【【F】】】】
180 Anti-HBeAg/HBe-Ab【【【【SC】】】】
--Positive --Negative
--Numerical Value _____【【【【F】】】】
181 Anti-HBeAg/HBe-Ab Upper Reference Limit (URL) _____【【【【F】】】】
182 Anti-HBcAg/HBc-Ab【【【【SC】】】】
--Positive --Negative
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--Numerical Value _____【【【【F】】】】
183 Anti-HBcAg/HBc-Ab Upper Reference Limit (URL) _____【【【【F】】】】
184 PreS1【【【【SC】】】】
--Positive --Negative
--Numerical Value _____【【【【F】】】】
185 PreS1 Upper Reference Limit (URL) _____【【【【F】】】】
186 HCV-Ab (Unspecified)【【【【SC】】】】
--Positive --Negative
--Numerical Value _____【【【【F】】】】
187 HCV-Ab (Unspecified) Upper Reference Limit (URL) _____【【【【F】】】】
188 HCV IgG【【【【SC】】】】
--Positive --Negative
--Numerical Value _____【【【【F】】】】
189 HCV IgG Upper Reference Limit (URL) _____【【【【F】】】】
190 HCV IgM【【【【SC】】】】
--Positive --Negative
--Numerical Value _____【【【【F】】】】
191 HCV IgM Upper Reference Limit (URL) _____【【【【F】】】】
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY DATA DICTIONARY
Study ID
Coding Instructions: Indicate the identification number for the study.
Medical Record Number
Coding Instructions: Indicate the identification number for this record.
Hospital Number
Coding Instructions: Indicate the identification number for this hospital.
Are Daily Records Included in This Medical Record?
Coding Instructions: Indicate if there are daily records available as a part of this medical record
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Definition per CORE team
Gender
Coding Instructions: Indicate the gender of the patient.
Selections: (1) Male (2) Female (3) Unrecorded
Age
Coding Instructions: Indicate the age of the patient in years.
Medical Insurance
Coding Instructions: Indicate the patient’s medical insurance status.
Target Value: N/A
Selections:
Payment Out-of-Pocket
Free Medical Care
Urban Residents/ Worker Medical Insurance
Comprehensive Arrangement for Serious Disease
New-Type Rural Cooperative Medical System (CMS)
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Poverty Assistance Insurance
Commercial Medical Insurance
Other Social Insurance
Unrecorded
Supporting Definitions:
Urban residents/worker medical insurance: the medical insurance provided by the
government for people who live in urban areas; also is the type of insurance provided by
a company or factory for their employees.
Farmer medical insurance: a new medical insurance type funded by the government for
farmers.
Business insurance: Insurance paid for by individuals to insurance companies.
Comprehensive arrangement for serious disease: Insurance for people living in urban
areas who are employed by a company or factory. Also may apply to persons who are
retired. Specifications vary by city. Covered diseases are different than that covered by
urban residents/worker medical insurance.
Poverty assistance insurance: Medical aid provided by the government for poverty-
stricken individuals to cover a portion of expenses
Free medical care: The government provides free medical treatment for a specific group
of people such as for disabled members of the armed forces.
Self-paying medical care: Indicated for those without medical insurance or for whom
certain diseases are not covered by insurance. Patient will pay for these costs.
Patients may have more than one insurance type at a given time. Abstractor should select all
that apply
Source: Definition per China team.
Height
Coding Instructions: Indicate the patient’s height in centimeters
Note(s): Measurement from the transferring facility is acceptable
Target Value: The first value between arrival at this facility and discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Admission Weight
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Coding Instructions: Indicate the patient’s weight in kilograms on admission
Note(s): Measurement from the transferring facility is acceptable
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Marital Status
Coding Instructions: Indicate the marital status of the patient
Target Value: N/A
Selections:
Married
Single
Divorced
Widowed
Unrecorded
Supporting Definitions:
Married – A formal union with a person of the opposite sex, typically as recognized by law, by
which they are considered husband and wife.
Single- Never been married.
Divorced – Previous marriage has been legally dissolved by a court or another legal body.
Widowed- A person who has lost his/her spouse to death and has not remarried.
Source: Definition per CORE team; Oxford English Dictionary
Occupation
Coding Instructions: Indicate the occupation of the patient
Target Value: N/A
Selections:
Retired
Worker (Industrial/Mining/Construction/Other Similar Type of Work)
Farmer
Office work
Cadre
Teacher
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Student
Physician
Businessman
Engineer
Policeman or Soldier
Freelancers
Unemployed
Other
Unrecorded
Supporting Definitions: Documentation of occupation by treating physician
Source: Definition per CORE team; China team
Ethnicity
Coding Instructions: Indicate the ethnicity of the patient
Target Value: N/A
Selections:
Han
Zhuang
Man
Hui
Miao
Weiwuer
Tujia
Yi
Menggu
Zang
Buyi
Other
Unrecorded
Supporting Definitions: The highlighted groups comprise the top 11 ethnicities by population
size among 56 ethnic groups within China.
Source: Definition per CORE team; China team
Nationality
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Coding Instructions: Indicate the nationality of the patient
Target Value: N/A
Selections:
China
Other
Unrecorded
Supporting Definition: Nationality is the status of belonging to a nation by origin, birth, or
naturalization
Source: Definition per CORE team; Oxford English Dictionary
Location of Residence
Coding Instructions: Indicate the patient’s location of resident based on the supporting definition.
Target Value: The value on arrival to facility
Selections: (1) Urban (2) Rural (3) Overseas (4) Unrecorded
Supporting Definitions:
Urban residence includes the areas of a city or municipality or Hong Kong, Macao and Taiwan
regions.
Rural residence includes the areas belonging to the countryside including associated townships
and villages.
Source: Definition per China team
Postal Code of Residence
Coding Instructions: Indicate patient’s postal code of primary residence
Target Value: The value on arrival to facility
Selections: (none)
Supporting Definitions: (none)
Source: Definition per China team
Date of Arrival at Your Hospital
Coding Instructions: Indicate the date the patient arrived at your facility.
Target Value: N/A
Selections: (none)
Supporting Definitions: (none)
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Source: Adapted from AHA Get with the Guidelines ACTION registry
Time of Arrival at Your Hospital
Coding Instructions: Indicate the time the patient arrived at your facility.
Target Value: N/A
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Was the Time of Arrival at Your Hospital Estimated?
Coding Instructions: Indicate if the time of arrival at your hospital was estimated.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team.
Did The Patient Receive Medical Assistance at an Outside Facility Prior to Arrival?
Coding Instructions: Indicate if the patient received medical assistance at an outside facility prior
to arrival.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Admission Date
Coding Instructions: Indicate the date the patient was admitted to your facility
Target Value: N/A
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Admission Time
Coding Instructions: Indicate the time the patient was admitted to your facility
Target Value: N/A
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Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Department of Admission
Coding Instructions: Indicate the department responsible for the patient admission.
Target Value: N/A
Selections: (1) Cardiovascular Department (2) Internal Medicine Department (3) Geriatrics (4)
Cadre’s Ward (5) CCU (6) ICU (7) Other (8) Unrecorded
Supporting Definitions: (none)
Source: Definition per China team
Patient Transferred from One Department to Another
Coding Instructions: Indicate if the patient was transferred to another department after initial
admission.
Target Value: N/A
Selections: (1) Yes (2) No (3) Unrecorded
Supporting Definitions: (none)
Source: Definition per China team
Discharge Department
Coding Instructions: Indicate the department responsible for the patient’s discharge.
Target Value: N/A
Selections: (1) Cardiovascular Department (2) Internal Medicine Department (3) Geriatrics (4)
Cadre’s Ward (5) CCU (6) ICU (7) Other (8) Unrecorded
Supporting Definitions: (none)
Source: Definition per China team
Discharge Date
Coding Instructions: Indicate the date the patient was discharged from your facility.
Target Value: N/A
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
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Date Diagnosis Was Confirmed
Coding Instructions: Indicate the date on which the principal discharge diagnosis was confirmed.
Target Value: N/A
Selections: N/A
Supporting Definitions: (none)
Source: Definition per CORE team
Gross Charge of Hospitalization in Yuan
Coding Instructions: Indicate total charge for patient hospitalization
Target Value: N/A
Selections: (none)
Supporting Definitions: The entire charge associated with hospitalization.
Source: Definition per China team
Time since Symptom Onset
Coding Instructions: How much time has passed since onset of ischemic symptoms?
Target Value: N/A
Selections: (1) ___ Days (2) ___Hours
Supporting Definitions: For patients undergoing elective angiography or PCI, indicate the time
passed since ischemic symptoms worsened (for patients with previous ischemic symptoms) or
the time since ischemic symptoms began (for patients without previous ischemic symptoms).
For those undergoing primary percutaneous coronary intervention in the setting of acute
coronary syndromes, indicate the time since the most recent ischemic symptoms began.
Source: Definition per CORE team; China team
Time of Symptom Onset (precise)
Coding Instructions: Indicate the time the patient first noted ischemic symptoms that lasted
greater than or equal to 10 minutes.
If an estimated symptom onset time is recorded, code 'symptom onset time estimated'.
Target Value: The first time symptoms lasted greater than 10 minutes on the symptom onset
date
Selections: (none)
Supporting Definitions: (none)
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Note: If the symptom onset time is not specified in the medical record, it may be recorded as
0700 for morning; 1200 for lunchtime; 1500 for afternoon; 1800 for dinnertime; 2200 for evening
and 0300 if awakened from sleep.
Source: Adapted from AHA Get with the Guidelines ACTION registry
Was Symptom Onset Time Estimated?
Coding Instructions: Indicate if the symptom onset time was estimated.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Patient Chest Discomfort
Coding Instructions: Did the patient experience chest symptoms including chest pain, chest
discomfort, chest pressure, or other chest symptoms?
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team, adapted from the AHA Get with the Guidelines ACTION
registry
Time of Duration of Chest Discomfort
Coding Instructions: How long did the patient’s chest discomfort last?
Target Value: N/A
Selections: (1) greater than or equal to 10 minutes; (2) less than 10 minutes; (3) unrecorded
Supporting Definitions: (none)
Source: Definition per CORE team; China team
Did the Patient Have Ischemic Symptoms Other than Chest Discomfort?
Coding Instructions: Indicate if there is physician documentation of other ischemic symptoms.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: Documentation of one or more of these symptoms warrants a “Yes”
answer: shortness of breath, pain at non-chest sites, nausea, vomiting, or fatigue
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Source: Definition per CORE team
Did Other Ischemic Symptoms Last 10 or More Minutes?
Coding Instructions: How long did other ischemic symptoms last?
Target Value: N/A
Selections: (1) No; (2) Yes; (3) unrecorded
Supporting Definitions: (none)
Source: Definition per CORE team; China team
Admission Diagnosis (Related to Coronary Heart Disease)
Coding Instructions: Indicate the admission diagnosis related to coronary heart disease
documented in the medical record.
Note(s): Mark as many of the choices that apply.
Selections: Coronary Heart Disease, Acute Coronary Syndrome, Acute Myocardial Infarction,
Acute Extensive Anterior Myocardial Infarction, Acute Anterior Myocardial Infarction, Acute
Septal Myocardial Infarction, Acute Inferior Myocardial Infarction, Acute Lateral Myocardial
Infarction, Acute Posterior Myocardial Infarction, Acute Right Ventricular Myocardial Infarction,
Acute Non ST-Elevation Myocardial Infarction, Acute ST-Elevation Myocardial Infarction,
Subendocardial Myocardial Infarction, Acute Myocardial Infarction Suspected, Previous (Q-
wave) Myocardial Infarction, Unstable Angina Pectoris, Stable Angina Pectoris, Prinzmetal's
Angina, Angina (Unrecorded Subtype), None of the Above Is Recorded.
Supporting Definition: If none of the above options is noted in the chart, mark “None of the
above is recorded”.
Source: Definition per CORE team
Admission Diagnosis (Unrelated to Coronary Heart Disease)
Coding Instructions: Indicate the admission diagnosis unrelated to coronary heart disease
documented in the medical record.
Note(s): Mark as many of the choices that apply.
Selections: Cardiac Arrest, Cardiogenic Shock, Ventricular Fibrillation/Ventricular Tachycardia,
Atrial Fibrillation, Acute Heart Failure, Chronic Heart Failure, Heart Failure (unspecified), Acute
Pulmonary Edema, Hemorrhagic Stroke (Cerebral Hemorrhage/Subarachnoid Hemorrhage),
Ischemic Stroke (Cerebral Infarction/Cerebral Embolism/Cerebral Thrombosis), Stroke
(Unspecified), Pneumonia, COPD Exacerbation, Gastrointestinal Bleeding, Acute Renal Failure,
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Chronic Renal Failure, Dialysis (Hemodialysis/Peritoneal Dialysis), Dyslipidemia, Hypertension,
Diabetes Mellitus, Diabetic Nephropathy, Gastroesophageal Reflux, Oesophagismus,
Cholelithiasis, Anemia, None of the Above Is Recorded.
Supporting Definition: If none of the above options is noted in the chart, mark “None of the
above is recorded”.
Source: Definition per CORE team
Antiplatelet Therapy Prior to Arrival
Coding Instructions: Indicate whether the patient was given aspirin, clopidogrel, ticlopidine or
other antiplatelet therapy by a health provider (EMS, transferring hospital, etc.) prior to arrival at
this hospital or if the patient self-administered aspirin after symptom onset.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Fibrinolysis Prior to Arrival
Coding Instructions: Indicate whether the patient was given a fibrinolytic by a health provider
(EMS, transferring hospital, etc.) prior to arrival at this hospital.
Target Value: N/A
Selections: (1) No (2) Yes. If yes, please specify the name of the fibrinolytic agent that was
used.
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
CPR/Chest Compressions Prior to Arrival
Coding Instructions: Indicate if cardiopulmonary resuscitation (CPR) in any form, including chest
compression, was performed for the patient, prior to arrival
Target Value: Any occurrence between first medical contact and arrival to this facility
Selections: (1) No (2) Yes
Supporting Definitions: CPR comprises of a series of interventions performed for patients with
sudden cardiac arrest in order to restore the perfusion and oxygenation of vital organs. Chest or
abdominal compression, ascertainment of patent airways, rescue breathing, as well as electrical
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cardioversion and defibrillation are the cornerstones of CPR. Medications (including
epinephrine, lidocaine, amiodarone, and atropine) may or may not be used during CPR.
Source: Definition per CORE team from: Field JM, Hazinski MF, Sayre MR, Chameides L,
Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch
EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi
JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M,
Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. Part 1: executive
summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S640–S656.
External Defibrillation Prior to Arrival
Coding Instructions: Indicate if there is documentation of electrical defibrillation by lay
responders or EMS personnel prior to arrival
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Temporary Cardiac Pacing Prior to Arrival
Coding Instructions: Indicate if there is documentation of temporary cardiac transcutaneous or
transvenous pacing by EMS personnel prior to arrival
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Cardiac Arrest Prior to Admission
Coding Instructions: Indicate if the patient had an episode of cardiac arrest prior to admission to
this facility.
Note(s): Evaluated by ED personnel and either (1) received attempts at external defibrillation or
chest compressions or (2) were pulseless but did not receive attempts to defibrillate or
cardiopulmonary resuscitation (CPR).
Target Value: Any occurrence prior to admission to this facility.
Selections: (1) No (2) Yes
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Supporting Definitions: 'Sudden' cardiac arrest is the sudden cessation of cardiac activity so that
the victim becomes unresponsive, with no normal breathing and no signs of circulation. If
corrective measures are not taken rapidly, this condition progresses to sudden death. Cardiac
arrest should be used to signify an event as described above that is reversed, usually by CPR,
and/or defibrillation or cardioversion, or cardiac pacing. Sudden cardiac arrest is not the same
as sudden cardiac death. Sudden cardiac death describes a fatal event.
Source: ACC/AHA/HRS 2006 Key Data Elements and Definitions for Electrophysiological
Studies and Procedures; adapted from AHA Get with the Guidelines ACTION registry
CPR/Chest Compressions in the Emergency Department Prior to Admission
Coding Instructions: Indicate if cardiopulmonary resuscitation (CPR) in any form, including chest
compression, was performed for the patient in the emergency department prior to admission
Target Value: Any occurrence between arrival to the ED and admission
Selections: (1) No (2) Yes
Supporting Definitions: CPR comprises of a series of interventions performed for patients with
sudden cardiac arrest in order to restore the perfusion and oxygenation of vital organs. Chest or
abdominal compression, ascertainment of patent airways, rescue breathing, as well as electrical
cardioversion and defibrillation are the cornerstones of CPR. Medications (including
epinephrine, lidocaine, amiodarone, and atropine) may or may not be used during CPR.
Source: Definition per CORE team from: Field JM, Hazinski MF, Sayre MR, Chameides L,
Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch
EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi
JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M,
Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. Part 1: executive
summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S640–S656.
External Defibrillation in Emergency Department Prior to Admission
Coding Instructions: Indicate if there is documentation of electrical defibrillation in the
emergency department prior to admission
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
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Temporary Cardiac Pacing In Emergency Department Prior to Admission
Coding Instructions: Indicate if there is documentation of temporary transcutaneous or
transvenous cardiac pacing in the emergency department prior to admission
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Fibrinolysis in Emergency Room Prior to Admission
Coding Instructions: Indicate if fibrinolysis was given in the emergency room prior to admission.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: If the patient received fibrinolysis, indicate the type of agent used
(streptokinase, urokinase, reteplase, or other).
Source: Definition per CORE team
Antiplatelet Therapy in the Emergency Department Prior to Admission
Coding Instructions: Indicate whether the patient was given aspirin, clopidogrel, ticlopidine or
other antiplatelet therapy by a health provider (EMS, transferring hospital personnel, etc.) in the
emergency department prior to admission.
Target Value: Any occurrence between arrival to the ED and admission
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Fibrinolysis in the Emergency Department Prior to Admission
Coding Instructions: Indicate whether the patient was given a fibrinolytic by a health provider
(EMS, transferring hospital, etc.) in the emergency department prior to admission.
Target Value: Any occurrence between arrival to the ED and admission
Selections: (1) No (2) Yes. If yes, please specify the name of the fibrinolytic agent that was
used.
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
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ACUTE COEXISTING CONDITIONS AT PRESENTATION TO THIS FACILITY
Heart Failure on Presentation to This Facility
Coding Instructions: Indicate if there is physician documentation or report of HF on presentation
to this facility
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Heart failure is defined as physician documentation or report of any of
the following clinical symptoms of heart failure, described as: unusual dyspnea on light exertion,
recurrent dyspnea occurring in the supine position, fluid retention; or the description of rales,
jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest
X-ray presumed to be due to cardiac dysfunction. A low ejection fraction without clinical
evidence of heart failure does not qualify as heart failure.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), The Society of
Thoracic Surgeons; adapted from AHA Get with the Guidelines ACTION registry
Cardiogenic Shock on Presentation to This Facility
Coding Instructions: Indicate if the patient was in a state of cardiogenic shock on presentation to
this facility.
Note(s): Transient episodes of hypotension reversed with IV fluid or atropine do not constitute
cardiogenic shock. The hemodynamic compromise (with or without extraordinary supportive
therapy) must persist for at least 30 minutes.
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Cardiogenic shock is defined as a sustained (>30 minutes) episode of
systolic blood pressure <90 mm Hg, and/or cardiac index <2.2 L/min/m2 determined to be
secondary to cardiac dysfunction, and/or the requirement for parenteral inotropic or vasopressor
agents or mechanical support (e.g., IABP, extracorporeal circulation, ventricular assist devices)
to maintain blood pressure and cardiac index above those specified levels.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30); adapted from
AHA Get with the Guidelines ACTION registry
Pneumonia on Presentation to This Facility
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Coding Instructions: Indicate if there is physician documentation or report of pneumonia on
presentation to this facility
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Pneumonia is defined as physician documentation of pneumonia plus
the presence of a demonstrable infiltrate by chest radiograph or other imaging.
Source: Infectious Diseases Society of America/American Thoracic Society consensus
guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis.
2007 Mar 1;44 Suppl 2:S27-72; definition per CORE team
COPD Exacerbation on Presentation to This Facility
Coding Instructions: Indicate if there is physician documentation or report of exacerbated
(acute) COPD on presentation to this facility
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Exacerbated COPD is defined as physician documentation of
exacerbated COPD. Other clinical signs and radiographic findings are non-specific.
Source: Definition per CORE team
Acute Stroke on Presentation to This Facility
Coding Instructions: Indicate if there is physician documentation or report of an acute stroke on
presentation to this facility.
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Acute stroke is defined as physician documentation of an acute stroke
Source: Definition per CORE team
Active Gastrointestinal Bleeding on Presentation to This Facility
Coding Instructions: Indicate if there is physician documentation or report of active
gastrointestinal bleeding on presentation to this facility.
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
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Supporting Definitions: Active gastrointestinal bleeding is defined as physician documentation of
active hematemesis (upper gastrointestinal bleeding), active hematochezia (lower
gastrointestinal bleeding), or active melena (upper gastrointestinal bleeding).
Source: Definition per CORE team
Acute Renal Failure on Presentation to This Facility
Coding Instructions: Indicate if there is physician documentation or report of acute renal failure
on presentation to this facility
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Acute renal failure is defined as physician documentation of acute renal
failure
Source: Definition per CORE team
NYHA Functional Classification on Arrival
Coding Instructions: Indicate the physician documentation of New York Heart Association
functional class on the patient’s arrival to this facility
Target Value: N/A
Selections:
I – No limitation of physical activity. Ordinary physical activity does not cause undue
fatigue, palpitation, or dyspnea (shortness of breath)
II – Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity
results in fatigue, palpitation, or dyspnea.
III – Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity
causes fatigue, palpitation, or dyspnea.
IV – Unable to carry out any physical activity without discomfort. Symptoms of cardiac
insufficiency present at rest. If any physical activity is undertaken, discomfort is increased.
Unrecorded
Supporting Definitions: The NYHA functional classification system relates symptoms to
everyday activities and the patient's quality of life.
Source: Definition per CORE team; The Criteria Committee of the New York Heart Association.
Diseases of the heart and blood vessels. In: Nomenclature and Criteria for Diagnosis. 7th ed.
Boston: Little, Brown, 1973:286.
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Killip Classification on Arrival
Coding Instructions: Indicate the physician documentation of Killip classification on the patient’s
arrival to this facility
Target Value: N/A
Selections:
I - No rales over the lung fields and no S3.
II - Rales 50% or less over the lung fields or presence of an S3. Includes patients
documented as having bibasilar rales.
III - Rales more than 50% of the lung fields/frank pulmonary edema. Includes patients
documented as having rales throughout.
IV - Cardiogenic Shock
Unrecorded
Supporting Definitions: Killip classification is a method of prognostication and risk-stratification in
patients with acute myocardial infarction.
Source: Adapted from VIRGO registry
PAST MEDICAL HISTORY – RELATED TO HEART DISEASE
History of Angina or Coronary Heart Disease
Coding Instructions: Mark “Yes”, if documented history of angina or coronary heart disease is
present
Target Value: Any occurrence between birth and arrival at this faciltiy
Selections: (1) No (2) Yes
Supporting Definitions: Indicate if there is physician documentation of history of angina or
history of coronary artery disease. Coronary heart disease may be abbreviated as CHD.
Presence of at least one of the two warrants a “Yes” answer.
Source: Definition per CORE team
History of Myocardial Infarction
Coding Instructions: Indicate if the patient has had at least one documented previous
myocardial infarction.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: A myocardial infarction is evidenced by any of the following:
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1. A rise and fall of cardiac biomarkers (preferably troponin) with at least one of the
values in the abnormal range for that laboratory [typically above the 99th percentile of
the upper reference limit (URL) for normal subjects] together with at least one of the
following manifestations of myocardial ischemia:
a. Ischemic symptoms.
b. ECG changes indicative of new ischemia (new ST-T changes, new left bundle
branch block, or loss of R wave voltage).
c. Development of pathological Q- waves in 2 or more contiguous leads in the
ECG (or equivalent findings for true posterior MI).
d. Imaging evidence of new loss of viable myocardium or new regional wall
motion abnormality.
e. Documentation in the medical record of the diagnosis of acute myocardial
infarction based on the cardiac biomarker pattern in the absence of any items
enumerated in a-d due to conditions that may mask their appearance (e.g., peri-
operative infarct when the patient cannot report ischemic symptoms; baseline left
bundle branch block or ventricular pacing).
2. ECG changes associated with prior myocardial infarction can include the following
(with or without prior symptoms):
a. Any Q-wave in leads V2-V3 >=0.02 seconds or QS complex in leads V2 and
V3.
b. Q-wave >=0.03 seconds and >=0.1 mV deep or QS complex in leads I, II, aVL,
aVF, or V4-V6 in any two leads of a contiguous lead grouping (I, aVL, V6; V4-V6;
II, III, and aVF).
c. R-wave >=0.04 seconds in V1-V2 and R/S >=1 with a concordant positive T-
wave in the absence of a conduction defect.
3. Imaging evidence of a region with new loss of viable myocardium at rest in the
absence of a non-ischemic cause. This can be manifest as:
a. Echocardiographic, CT, MR, ventriculographic or nuclear imaging evidence of
left ventricular thinning or scarring and failure to contract appropriately (i.e.,
hypokinesis, akinesis, or dyskinesis).
b. Fixed (non-reversible) perfusion defects on nuclear radioisotope imaging (e.g.,
MIBI, thallium).
4. Medical record documentation of prior myocardial infarction.
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Source: Joint ESC-ACC-AHA-WHF 2007 Task Force Consensus Document "Universal
Definition of Myocardial Infarction"; adapted from AHA Get with the Guidelines ACTION registry
Family History of CAD
Coding Instructions: Indicate if the patient has a family history of coronary artery disease.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Note(s): If the patient is adopted, or the family history is unavailable, code "No".
Supporting Definitions: Family History of Premature CAD Among Direct Relatives:
Family history includes any direct blood relatives (parents, siblings, children) who have had any
of the following diagnosed at age less than 55 years for male relatives or less than 65 years for
female relatives:
a. Angina
b. Acute myocardial infarction
c. Sudden cardiac death without obvious cause
d. Coronary artery bypass graft surgery
e. Percutaneous coronary intervention
Source: Adapted from AHA Get with the Guidelines CATH-PCI registry
History of Heart Failure
Coding Instructions: Indicate if there is a previous history of heart failure.
Note(s): A previous hospital admission with principal diagnosis of heart failure is considered
evidence of heart failure history.
Target Value: Any occurrence between birth and arrival at this facility
Selection: (1) No (2) Yes
Supporting Definitions: Heart failure is defined as physician documentation or report of any of
the following clinical symptoms of heart failure described as unusual dyspnea on light exertion,
recurrent dyspnea occurring in the supine position, fluid retention; or the description of rales,
jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest
X-ray presumed to be cardiac dysfunction. A low ejection fraction without clinical evidence of
heart failure does not qualify as heart failure.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), The Society of
Thoracic Surgeons; adapted from AHA Get with the Guidelines ACTION registry
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History of Percutaneous Coronary Intervention
Coding Instructions: Indicate if the patient had a previous percutaneous coronary intervention
(PCI) of any type (balloon angioplasty, stent or other).
Note (s): Timeframe does NOT include the current admission.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: A percutaneous coronary intervention (PCI) is the placement of an
angioplasty guide wire, balloon, or other device (e.g. stent, atherectomy, brachytherapy, or
thrombectomy catheter) into a native coronary artery or coronary artery bypass graft for the
purpose of mechanical coronary revascularization.
Source: Adapted from AHA Get with the Guidelines ACTION registry
If Patient Had a Prior PCI, Most Recent PCI Date
Coding Instructions: Indicate the date of most recent PCI.
Target Value: N/A
Supporting Definitions: (none)
Selections: Choose one of the following:
a. <1 Month Ago
b. 1-5 Months Ago
c. 6-12 Months Ago
d. 1-2 Years Ago
e. >2 Years Ago
f. Unrecorded
Note(s): If month or day are unknown enter 01.
Source: Adapted from AHA Get with the Guidelines CATH-PCI registry
History of Fibrinolysis
Coding Instructions: Indicate if the patient has previously received intravenous fibrinolysis.
Note(s): Timeframe does NOT include the current admission.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
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History of CABG
Coding Instructions: Indicate whether the patient had a coronary artery bypass graft (CABG).
Note(s): Timeframe does NOT include the current admission.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
If Patient Had a Prior CABG, Most Recent CABG Date【【【【SC】】】】
Coding Instructions: Indicate the date of most recent CABG.
Target Value: N/A
Selections:
a. <1 Month Ago
b. 1-5 Months Ago
c. 6-12 Months Ago
d. 1-2 Years Ago
e. >2 Years Ago
f. Unrecorded
Supporting Definitions: (none)
Note(s): If month or day are unknown enter 01.
Source: Adapted from AHA Get with the Guidelines CATH-PCI registry
History of Atrial Fibrillation or Flutter
Coding Instructions: Indicate if there is a previous history of atrial fibrillation or flutter
Note(s): Code "No" if patient was first diagnosed with atrial fibrillation or flutter after reperfusion
during this admission. If there is no prior documentation of atrial arrhythmias, it is acceptable to
code "No"
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
History of Ventricular Tachycardia or Ventricular Fibrillation
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Coding Instructions: Indicate if there is a previous history of ventricular tachycardia or ventricular
fibrillation
Note(s): Code "No" if patient was first diagnosed with ventricular tachycardia or fibrillation after
reperfusion during this admission. If there is no prior documentation of ventricular arrhythmias, it
is acceptable to code "No"
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
History of Permanent Pacemaker
Coding Instructions: Indicate if the patient has a history of having a permanent pacemaker
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: Permanent pacemaker includes single-chamber, dual chamber, and
biventricular pacemakers
Source: Definition per CORE team
History of Bradycardia
Coding Instructions: Indicate if there is chart documentation for a previous history bradycardia.
Note(s): Code "No" if patient was first diagnosed with bradycardia during this admission. If there
is no prior documentation of bradycardia, it is acceptable to code "No".
Target Value: Any occurrence between birth and arrival at this facility.
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
History of Valvular Heart Disease
Coding Instructions: Indicate if there is chart documentation for a previous history of valvular
heart disease.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
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Supporting Definitions: Valvular heart diseases include but are not limited to tricuspid stenosis,
tricuspid regurgitation, pulmonic stenosis, pulmonic regurgitation, mitral stenosis, mitral
regurgitation, aortic stenosis, and aortic regurgitation.
Source: Definition per CORE team
GENERAL PAST MEDICAL HISTORY
History of Hypertension
Coding Instructions: Indicate if the patient has been diagnosed previously with hypertension
Note(s): Code "No" if hypertension was first diagnosed after reperfusion during this admission.
Selections: (1) No (2) Yes
Target Value: Any occurrence between birth and arrival at this facility
Supporting Definitions: Hypertension is defined by any one of the following:
1. History of hypertension diagnosed and treated with medication, diet and/or exercise
2. Prior documentation of blood pressure greater than 140 mm Hg systolic and/or 90 mm
Hg diastolic for patients without diabetes or chronic kidney disease, or prior
documentation of blood pressure greater than 130 mm Hg systolic or 80 mm Hg diastolic
on at least two occasions for patients with diabetes or chronic kidney disease.
3. Currently on pharmacological therapy for the treatment of hypertension.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), The Society of
Thoracic Surgeons; adapted from AHA Get with the Guidelines ACTION registry
History of Dyslipidemia
Coding Instructions: Indicate if the patient has a history of dyslipidemia diagnosed and/or
treated by a physician.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Dyslipidemia is defined by the National Cholesterol Education Program
criteria and includes documentation of the following:
1. Total cholesterol greater than 200 mg/dL (5.18 mmol/l); or
2. Low-density lipoprotein (LDL) greater than or equal to 130 mg/dL (3.37 mmol/l); or
3. High-density lipoprotein (HDL) less than 40 mg/dL (1.04 mmol/l).
4. Currently on pharmacologic therapy for the treatment of dyslipidemia.
For patients with known coronary artery disease, treatment is initiated if LDL is greater
than 100 mg/dL (2.59 mmol/l), and this would qualify as hypercholesterolemia.
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Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), The Society of
Thoracic Surgeons; adapted from AHA Get with the Guidelines ACTION registry
History of Chronic Renal Failure
Coding Instructions: Indicate if the patient has a history of chronic renal failure
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Chronic renal failure can be coded for any of the following:
1. A documented history of renal failure, and/or
2. A history of creatinine > 2.0 mg/dL, and/or
3. A documented history of chronic renal disease
Prior renal transplant patients are not included unless creatinine has been >2.0 mg/dL
since transplantation
Source: Adapted from VIRGO registry
Currently on Dialysis
Coding Instructions: Indicate if the patient is currently undergoing either hemodialysis or
peritoneal dialysis on an ongoing basis as a result of renal failure.
Note(s): Code "No" if patient was not on dialysis until after reperfusion during this admission.
Target Value: The value on arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
History of Chronic Lung Disease
Coding Instructions: Indicate if the patient has a history of chronic lung disease.
A history of chronic inhalation reactive disease (asbestosis, mesothelioma, black lung disease
or pneumoconiosis) qualifies as chronic lung disease. Radiation induced pneumonitis or
radiation fibrosis also qualifies as chronic lung disease. A history of atelectasis is a transient
condition and does not qualify.
Notes: Code "No" if patient was first diagnosed with chronic lung disease after reperfusion
during this admission.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
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Supporting Definitions: Chronic lung disease can include patients with chronic obstructive
pulmonary disease, chronic bronchitis, or emphysema. It can also include a patient who is
currently being chronically treated with inhaled or oral pharmacological therapy (e.g., beta-
adrenergic agonist, anti-inflammatory agent, leukotriene receptor antagonist, or steroid).
Patients with asthma or seasonal allergies are not considered to have chronic lung disease.
Source: Adapted from AHA Get with the Guidelines ACTION registry
History of Peripheral Vascular Disease
Coding Instructions: Indicate if there is physician documentation of a history of peripheral
vascular disease
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: Mark “Yes” if there is exact mention of “a history of peripheral vascular
disease,” or extremity claudication, or history of lower extremity percutaneous or surgical
revascularization procedure.
Source: Definition per CORE team
History of Diabetes Mellitus. History and Risk Factors
Coding Instructions: Indicate if the patient has a history of diabetes mellitus, regardless of
duration of disease or need for antidiabetic agents.
Note(s): Code "No" if the patient was first diagnosed with diabetes mellitus after reperfusion
during this admission.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Diabetes mellitus is diagnosed by a physician or can be defined as a
fasting blood sugar greater than 7 mmol/l or 126 mg/dL. It does not include gestational diabetes.
Diabetes mellitus can also be identified by history of pharmacologic treatment for condition.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), The Society of
Thoracic Surgeons; adapted from AHA Get with the Guidelines ACTION registry
History of Hepatitis B Infection
Coding Instructions: Mark “Yes”, if documented history of hepatitis B infection
Target Value: N/A
Selections: (1) No (2) Yes
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Supporting Definitions: (none)
Source: Definition per CORE team
History of Hepatitis C Infection
Coding Instructions: Mark “Yes”, if documented history of hepatitis C infection
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
History of Liver Cirrhosis
Coding Instructions: Mark “Yes”, if documented history of liver cirrhosis is present
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Prior Carotid Artery Surgery/Intervention
Coding Instructions: Indicate if the patient has a history of prior carotid artery surgery or stenting
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Previous carotid artery surgery/ intervention for carotid artery stenosis.
This does not include neurological disease processes such as metabolic and/or anoxic ischemic
encephalopathy.
Source: The Society of Thoracic Surgeons; adapted from AHA Get with the Guidelines ACTION
registry
Prior Ischemic Stroke
Coding Instructions: Indicate if the patient has had an ischemic stroke.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: A prior stroke is defined as any confirmed neurological deficit of abrupt
onset caused by a disturbance in cerebral blood supply that did not resolve within 24 hours.
Source: Adapted from AHA Get with the Guidelines ACTION registry
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Prior Hemorrhagic Stroke
Coding Instructions: Indicate if the patient has had a hemorrhagic stroke.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: A prior stroke is defined as any confirmed neurological deficit of abrupt
onset caused by a disturbance in cerebral blood supply that did not resolve within 24 hours.
Source: Adapted from AHA Get with the Guidelines ACTION registry
Prior Stroke, Unknown Subtype
Coding Instructions: Indicate if the patient has had a stroke, but subtype (ischemic,
hemorrhagic) is unknown.
Target Value: Any occurrence between birth and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: A prior stroke is defined as any confirmed neurological deficit of abrupt
onset caused by a disturbance in cerebral blood supply that did not resolve within 24 hours.
Source: Adapted from AHA Get with the Guidelines ACTION registry
PERSONAL HISTORY
Smoking History
Coding Instructions: Indicate the smoking status of the patient
Target Value: N/A
Selections: (1) Never smoked (2) Current Smoker (3) Past Smoker (4) Unrecorded
Supporting Definitions: Past smoker is defined as a person who was a daily smoker in the past
and stopped smoking at least three months prior to admission date, or chart documentation of
“past smoker”
Source: Definition per CORE team, based on: McCabe RE, Chudzik SM, Antony MM, Young L,
Swinson RP, Zolvensky MJ. Smoking behaviors across anxiety disorders. J Anxiety Disord
2004; 18: 7-18.
Smoking Duration among Current Smokers
Coding Instructions: Indicate the duration of time since the patient first started smoking
Target Value: N/A
Selections: (none)
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Supporting Definitions: Provide the duration in months
Source: Definition per CORE team
Smoking Duration for Past Smokers
Coding Instructions: Indicate the duration of time between when the patient first started smoking
and the cessation of smoking
Target Value: N/A
Selections: (none)
Supporting Definitions: Provide the duration in months
Source: Definition per CORE team
Smoking Frequency
Coding Instructions: Indicate the average number of cigarettes smoked per day
Target Value: N/A
Selections: (none)
Supporting Definitions: Provide the information as cigarettes per day
Source: Definition per CORE team
PHYSICAL EXAMINATION
Heart Rate at Presentation to This Facility
Coding Instructions: Indicate the first measurement or earliest record of heart rate (in beats per
minute).
Note(s): Measurement from EMS or the transferring facility is also acceptable.
Target Value: The first value after arrival at this facility
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Systolic Blood Pressure at Presentation to This Facility
Coding Instructions: Indicate the first measurement or earliest record of systolic blood pressure
(in mm Hg).
Note(s): Measurement from EMS or the transferring facility is also acceptable.
Target Value: The first value after arrival at this facility
Selections: (none)
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Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Diastolic Blood Pressure at Presentation to This Facility
Coding Instructions: Indicate the first measurement or earliest record of diastolic blood pressure
(in mm Hg).
Note(s): Measurement from EMS or the transferring facility is also acceptable.
Target Value: The first value after arrival at this facility
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Temperature at Presentation to This Facility
Coding Instructions: Indicate the first measurement or earliest record of temperature (degrees
Celsius).
Note(s): Measurement from EMS or the transferring facility is also acceptable.
Target Value: The first value after arrival at this facility
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Respiratory Rate at Presentation to This Facility
Coding Instructions: Indicate the first measurement or earliest record of respiratory rate (breaths
per minute).
Note(s): Measurement from EMS or the transferring facility is also acceptable.
Target Value: The first value after arrival at this facility
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Specify Home Medications
Coding Instructions: Indicate the names of medications been taken by patient routinely at home
prior to this hospitalization
Note(s): "Routinely" refers to the daily use of medications as prescribed, even if the patient
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misses a dose
Target Value: Any occurrence between 2 weeks prior to first medical contact and first medical
contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
AUXILIARY EXAMINATION
ECG at Hospital
Coding Instructions: Indicate if an ECG was obtained at the hospital
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: This will be considered for the first 3 ECGs.
Source: Definition per CORE team
Date of ECG at Hospital
Coding Instructions: Indicate the date ECG was obtained at presentation to the hospital
Target Value: N/A
Selections: (none)
Supporting Definitions: This will be considered for the first 3 ECGs.
Source: Definition per CORE team
Time of ECG at Hospital
Coding Instructions: Indicate the time ECG was obtained at presentation to the hospital
Target Value: N/A
Selections: (none)
Supporting Definitions: This will be considered for the first 3 ECGs.
Source: Definition per CORE team
ECG Results
Coding Instructions: Indicate the documented physician interpretation of the ECG
Note(s): Mark as many of the choices that apply.
Target Value: N/A
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Selections: (1) acute myocardial infarction (2) left bundle branch block (3) ST-elevation
myocardial infarction (4) ST-Depression (5) Q-wave myocardial infarction (6) ventricular
fibrillation (7) ventricular tachycardia (8) atrial fibrillation (9) 2nd degree atrioventricular block
type 1 (10) 2nd degree atrioventricular block type 2 (11) 3rd degree atrioventricular block
Source: Definition per China team
OTHER DIAGNOSTIC TESTS
Chest X-Ray
Coding Instructions: Indicate whether the patient underwent a chest X-ray or not
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Echocardiography
Coding Instructions: Indicate whether the patient underwent echocardiography or not
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Echocardiography Ejection Fraction (EF) Value
Instructions: Indicate the value of EF in percent documented in the echocardiography report.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (none)
Supporting Definition: LVEF: The left ventricular ejection fraction is the percentage of the blood
emptied from the left ventricle at the end of the contraction. The left ventricular ejection fraction
can be assessed via invasive (i.e. LV gram) or noninvasive (i.e. Echo, MR, CT or Nuclear)
testing.
Source: ACC Clinical Data Standards, The Society of Thoracic Surgeons; adapted from AHA
Get with the Guidelines ACTION registry
Stress Testing
Coding Instructions: Indicate whether the patient underwent stress testing or not
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Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines registry
Type of Stress Test
Coding Instructions: Indicate the type of stress testing performed
Target Value: N/A
Selections:
1. ECG only
2. With imaging
a. Nuclear (SPECT/PET)
b. Echocardiography
c. Cardiac MRI
d. Unrecorded
Supporting Definition: (none)
Source: Modified from AHA Get with the Guidelines ACTION registry
Method of Stress Test
Coding Instructions: Indicate method of performing stress test
Target Value: N/A
Selections: (1) Exercise (2) Pharmacologic (3) Unknown
Supporting Definition: (none)
Source: Adapted from VIRGO registry
Stress Test Results
Coding Instructions: Indicate the results of the stress test.
Target Value: N/A
Selections: (1) Negative (2) Positive (3) Indeterminate (4) Unrecorded
Supporting Definition: (none)
Source: Definition per CORE team.
Cardiac CT Angiogram
Coding Instructions: Indicate if the patient received a cardiac CT scan (Cardiac Cat Scan)
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Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Adapted from VIRGO registry
Coronary Calcium Score
Coding Instructions: Indicate the reported coronary calcium score from the cardiac CT
angiogram.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definition: The score is usually reported in Hounsfield units.
Source: Adapted from VIRGO registry
LABORATORY TESTS
Initial Myohemoglobin Date and Time
Coding Instructions: Indicate the date and time when the initial myohemoglobin sample was
collected (not the date results reported).
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Units of Myohemoglobin
Coding Instructions: Indicate the sample unit of measure of myohemoglobin level.
Target Value: N/A
Selections:
(1) IU/L
(2) ng/ml
(3) mg/mL
(4) Other
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Myohemoglobin Value
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Coding Instructions: Indicate myohemoglobin value.
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Maximum Myohemoglobin Date and Time
Coding Instructions: Indicate the date and time of collection of the maximum myohemoglobin
value.
Target Value: Any occurrence during the entire hospital stay
Selections: N/A
Supporting Definition: (none)
Source: Definition per CORE team
Maximum Myohemoglobin Value
Coding Instructions: Indicate the value of maximum myohemoglobin.
Target Value: Any occurrence during the entire hospital stay
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Creatine Kinase (CK) Value
Coding Instructions: Indicate the value of the initial CK.
Notes: Initial CK level corresponds to the first sample obtained within the first 24 hours of care.
It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of Creatine Kinase (CK) Level
Coding Instructions: Indicate the sample unit of measure of CK level.
Target Value: N/A
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Selections:
(1) IU/L
(2) %
(3) (mg/mL)/IU
(4) ng/mL
(5) mg/IU
(6) MI/IU
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial CK Upper Limit of Normal (ULN)
Coding Instructions: Indicate the ULN of the initial CK sample.
Note(s): If a range is given for ULN values, record the highest number in the range.
Examples: If the reference range given is 0.0-1.5, record ULN as 1.5. If the reference range
given is < 1.5, record ULN as 1.5 as well.
The initial sample value refers to the first sample obtained within the first 24 hours of care.
Target Value: N/A
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Creatine Kinase (CK) Date and Time
Coding Instructions: Indicate the date and time of collection of the initial CK.
Notes: Initial CK level corresponds to the first sample obtained within the first 24 hours of care.
It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Creatine Kinase (CK) Level
Coding Instructions: Indicate the maximum CK level recorded during hospital stay.
Target Value: Any occurrence during the entire hospital stay.
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Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Creatine Kinase (CK) Date and Time
Coding Instructions: Indicate the date and time of collection of the maximum CK.
Target Value: Any occurrence during the entire hospital stay
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial CK-MB Value
Coding Instructions: Indicate the value of the initial CK-MB.
Notes: If a CK-MB value was not calculated at baseline for normal CPK results, record a value
of 0 (zero). Initial CK level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial CK-MB Date and Time
Coding Instructions: Indicate the date and time of collection of the initial CK-MB.
Notes: Initial CK level corresponds to the first sample obtained within the first 24 hours of care.
It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of CK-MB Level
Coding Instructions: Indicate the sample unit of measure of CK-MB level.
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Target Value: N/A
Selections:
(1) IU/L
(2) %
(3) (mg/mL)/IU
(4) ng/mL
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial CK-MB Upper Limit of Normal (ULN)
Coding Instructions: Indicate the ULN of the initial CK-MB sample.
Note(s): If a range is given for ULN values, record the highest number in the range.
Examples: If the reference range given is 0.0-1.5, record ULN as 1.5. If the reference range
given is < 1.5, record ULN as 1.5 as well.
The initial sample value refers to the first sample obtained within the first 24 hours of care.
Target Value: N/A
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin I Value
Coding Instructions: Indicate the value of initial troponin I.
Notes: Initial troponin I level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: (1) Positive (2) Negative (3) Trace (+/-) (4) Numerical value
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of Troponin I
Coding Instructions: Indicate the sample unit of measure of troponin I level.
Target Value: N/A
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Selections: (1) ng/mL (2) Other
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin I Upper Reference Limit (URL)
Coding Instructions: Indicate the URL of the initial troponin I sample.
Target Value: N/A
Selections: N/A
Supporting Definition: Upper Reference Limit (URL):
Defined as the 99th percentile of troponin levels for a normal reference population.
Source: Joint ESC-ACC-AHA-WHF 2007 Task Force consensus document "Universal Definition
of Myocardial Infarction"; adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin I Date and Time
Coding Instructions: Indicate the date and time of collection of the initial troponin I.
Notes: Initial troponin I level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Troponin I Level
Coding Instructions: Indicate the maximum troponin I level recorded during hospital stay.
Target Value: Any occurrence during the entire hospital stay.
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Troponin I Date and Time
Coding Instructions: Indicate the date and time of collection of the maximum troponin I.
Target Value: Any occurrence during the entire hospital stay
Selections: N/A
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Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin T Value
Coding Instructions: Indicate the value of initial troponin T.
Notes: Initial troponin T level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of Troponin T
Coding Instructions: Indicate the sample unit of measure of troponin T level.
Target Value: N/A
Selections: (1) ng/mL (2) Other
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin Upper Reference Limit (URL)
Coding Instructions: Indicate the URL of the initial troponin T sample.
Target Value: N/A
Selections: N/A
Supporting Definition: Upper Reference Limit (URL):
Defined as the 99th percentile of troponin levels for a normal reference population.
Source: Joint ESC-ACC-AHA-WHF 2007 Task Force consensus document "Universal Definition
of Myocardial Infarction"
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin T Date and Time
Coding Instructions: Indicate the date and time of collection of the initial troponin T.
Notes: Initial troponin level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
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Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Troponin T Level
Coding Instructions: Indicate the maximum troponin T level recorded during hospital stay.
Target Value: Any occurrence during the entire hospital stay.
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Troponin T Date and Time
Coding Instructions: Indicate the date and time of collection of the maximum troponin T.
Target Value: Any occurrence during the entire hospital stay
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of Troponin (Unspecified)
Coding Instructions: Indicate the unit for measurement of troponin (unspecified).
Target Value: N/A
Selections: (1) Ng/mL, (2) IU/L or U/L (3) Other
Supporting Definition: (none)
Source: Definition per CORE team.
Initial Troponin (Unspecified) Value
Coding Instructions: Indicate if the results for the initial troponin (unspecified) test were positive
or negative
Target Value: the first troponin collected.
Selections: 1) Positive, 2) Negative 3) Numerical Value
Supporting Definition: (none)
Source: Definition per CORE team.
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Initial Troponin (Unspecified) Value
Coding Instructions: Indicate the value of initial troponin.
Notes: Initial troponin level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Definition per CORE team
Initial Troponin (Unspecified) Upper Reference Limit (URL)
Coding Instructions: Indicate the URL of the initial troponin (unspecified) sample.
Target Value: N/A
Selections: N/A
Supporting Definition: Upper Reference Limit (URL):
Defined as the 99th percentile of troponin levels for a normal reference population.
Source: Joint ESC-ACC-AHA-WHF 2007 Task Force consensus document "Universal Definition
of Myocardial Infarction"; adapted from AHA Get with the Guidelines ACTION registry
Initial Troponin (Unspecified) Date and Time
Coding Instructions: Indicate the date and time of collection of the initial troponin (unspecified).
Notes: Initial troponin level corresponds to the first sample obtained within the first 24 hours of
care. It may also have been collected at the transferring hospital.
Target Value: Any occurrence between first medical contact and 24 hours after arrival at first
facility
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Troponin (Unspecified) Level
Coding Instructions: Indicate the maximum troponin level (unspecified) recorded during hospital
stay.
Target Value: Any occurrence during the entire hospital stay.
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Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Troponin (Unspecified) Date and Time
Coding Instructions: Indicate the date and time of collection of the maximum troponin
(unspecified).
Target Value: Any occurrence during the entire hospital stay
Selections: N/A
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Hemoglobin Date and Time
Coding Instructions: Indicate the date and time when the initial hemoglobin sample was
collected (not the date results reported).
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Hemoglobin Value
Coding Instructions: Indicate hemoglobin value in mg/dL.
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Lowest Recorded Hemoglobin Date and Time
Coding Instructions: Indicate the date and time when the hemoglobin sample with the lowest
value was collected (not the date results reported).
Target Value: Any occurrence between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
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Lowest Recorded Hemoglobin Value
Coding Instructions: Indicate the lowest hemoglobin value available in mg/dL.
Target Value: Any occurrence between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Last Hemoglobin Date and Time
Coding Instructions: Indicate the date and time when the last hemoglobin sample during hospital
stay was collected (not the date results reported).
Target Value: Last value prior to discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Last Hemoglobin Value
Coding Instructions: Indicate the last hemoglobin value available in mg/dL.
Target Value: Last value prior to discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Minimum Hematocrit Date and Time
Coding Instructions: Indicate the date and time of the hematocrit sample that yielded the
minimum value (not the date results reported).
Target Value: The minimum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Minimum Hematocrit Value
Coding Instructions: Indicate minimum hematocrit value in %.
Target Value: The minimum value between first medical contact and discharge
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Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Last Recorded Hematocrit Date and Time
Coding Instructions: Indicate the date and time when the last hematocrit sample was collected
(not the date results reported).
Target Value: Last occurrence between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Last Recorded Hematocrit Value
Coding Instructions: Indicate the last hematocrit value available in %.
Target Value: Last occurrence between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial WBC Date and Time
Coding Instructions: Indicate the date and time when the initial WBC count was collected (not
the date results reported).
Target Value: The first available value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from VIRGO registry
Initial WBC Value
Coding Instructions: Record the first available WBC count (x103/µL)
Target Value: The first available value between first medical contact and discharge.
Selections: (none)
Supporting Definition: (none)
Source: Adapted from VIRGO registry
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Initial Neutrophil Count Date and Time
Coding Instructions: Indicate the date and time when the neutrophil count was collected (not the
date results reported).
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Neutrophil Count Value
Coding Instructions: Record the initial neutrophil count (x103/µL)
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Neutrophil Ratio
Coding Instructions: Record the initial neutrophil ratio
Target Value: The first value between first medical contact and discharge
Selections: (none)
Supporting Definition: This should be derived from the differentials of the complete blood count
(CBC)
Source: Definition per CORE team
Initial Platelet Count Date and Time
Coding Instructions: Indicate the date and time when the platelet count was collected (not the
date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Platelet Count Value
Coding Instructions: Record the first available platelet count (x109/µL)
Target Value: First value between first medical contact and discharge
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Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Minimum Platelet Count Date and Time
Coding Instructions: Indicate the date and time when the platelet count with the minimum value
was collected (not the date results reported).
Target Value: Lowest value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Minimum Platelet Count Value
Coding Instructions: Record the lowest available platelet count (x109/µL)
Target Value: Lowest value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Hemoglobin A1c Value
Coding Instructions: Record the most recent hemoglobin A1c in % obtained in the past 3
months.
Target Value: The most recent value obtained in the past 3 months
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial LDH Date and Time
Coding Instructions: Indicate the date and time when the initial LDH sample was collected (not
the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
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Initial LDH Value
Coding Instructions: Record the first available LDH value (mg/dL)
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Blood Glucose Value
Coding Instructions: Record the first available blood glucose value (mg/dL)
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial AST Level Date and Time
Coding Instructions: Indicate the date and time when the AST levels were collected (not the
date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial AST level Value
Coding Instructions: Record the first available AST level. (IU/L)
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Maximum AST Level Date and Time
Coding Instructions: Indicate the date and time when the maximum AST levels were collected
(not the date results reported).
Target Value: Maximum value between first medical contact and discharge
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Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Maximum AST level Value
Coding Instructions: Record the maximum available AST level (IU/L).
Target Value: Maximum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Minimum AST Level Date and Time
Coding Instructions: Indicate the date and time when the minimum AST levels were collected
(not the date results reported).
Target Value: Minimum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Minimum AST level Value
Coding Instructions: Record the minimum available AST level (IU/L).
Target Value: Minimum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial ALT Level Date and Time
Coding Instructions: Indicate the date and time when the initial ALT levels were collected (not
the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
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Initial ALT level Value
Coding Instructions: Record the first available ALT level. (IU/L).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Maximum ALT Level Date and Time
Coding Instructions: Indicate the date and time when the maximum ALT levels were collected
(not the date results reported).
Target Value: Maximum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Maximum ALT level Value
Coding Instructions: Record the maximum available ALT level (IU/L).
Target Value: Maximum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Minimum ALT Level Date and Time
Coding Instructions: Indicate the date and time when the minimum ALT levels were collected
(not the date results reported).
Target Value: Minimum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Minimum ALT Level Value
Coding Instructions: Record the minimum available ALT level (IU/L).
Target Value: Minimum value between first medical contact and discharge
Selections: (none)
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Supporting Definition: (none)
Source: Definition per CORE team
Initial Total Bilirubin Date and Time
Coding Instructions: Indicate the date and time when the initial total bilirubin levels were
recorded (not the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Total Bilirubin Value
Coding Instructions: Record the first available total bilirubin level (IU/L).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Direct Bilirubin Date and Time
Coding Instructions: Indicate the initial date and time when the direct bilirubin levels were
collected (not the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Direct Bilirubin Value
Coding Instructions: Record the first available direct bilirubin level (IU/L).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial Creatinine Date and Time
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Coding Instructions: Indicate the date and time when the creatinine levels were recorded (not
the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial Creatinine Value
Coding Instructions: Record the first available creatinine level (mg/dL).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Creatinine Date and Time
Coding Instructions: Indicate the date and time when the creatinine levels with maximum value
were collected (not the date results reported).
Target Value: Maximum occurrence between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum Creatinine Value
Coding Instructions: Record the maximum available creatinine level (mg/dL).
Target Value: Maximum occurrence between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Last Creatinine Date and Time
Coding Instructions: Indicate the date and time when the last creatinine levels with last value
were collected (not the date results reported).
Target Value: Last available value between the first medical contact and discharge
Selections: (none)
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Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Last Creatinine Value
Coding Instructions: Record the last available creatinine level (mg/dL).
Target Value: Last available value between the first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of BUN
Coding Instructions: indicate the unit of BUN.
Target Value: N/A
Selections: (1) Mgmg/dl (2) mmol/L (3) Other Supporting Definition: (none)
Source: Definition per CORE team.
Initial BUN Date and Time
Coding Instructions: Indicate the date and time when the initial BUN levels were recorded (not
the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial BUN Value
Coding Instructions: Record the first available BUN level.
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum BUN Date and Time
Coding Instructions: Indicate the date and time when the maximum BUN levels were collected
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(not the date results reported).
Target Value: Maximum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Maximum BUN Value
Coding Instructions: Record the maximum BUN value
Target Value: Maximum value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial BNP Date and Time
Coding Instructions: Indicate the date and time when the BNP levels were collected (not the
date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial BNP Value
Coding Instructions: Record the first available BNP level (pg/ml).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial NT-BNP Date and Time
Coding Instructions: Indicate the date and time when the initial NT-BNP levels were collected
(not the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
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Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial NT-BNP Value
Coding Instructions: Record the first available NT-BNP level (pg/ml).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of BNP/NT-proBNP
Coding Instructions: indicate the unit of BNP or NT-proBNP.
Target Value: N/A
Selections: 1) Pg/mL, 2) Ug/L, 3) Ug/mL, 4) Fmol/L, 5) other
Supporting Definition: (none)
Source: Definition per CORE team.
Initial Lipid Panel Date and Time
Coding Instructions: Indicate the date and time the first sample was collected (not the date
results reported).
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Unit of Lipids
Coding Instructions: indicate the unit of lipids.
Target Value: N/A
Selections: (1) Mg/dl (2) Mmol/L (3)Other
Supporting Definition: (none)
Source: Definition per CORE team.
Total Cholesterol Value
Coding Instructions: Indicate the total cholesterol value in mg/dL.
Notes: If multiple total cholesterol samples were collected, the first one should be preferentially
abstracted.
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Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
HDL Cholesterol Value
Coding Instructions: Indicate the HDL cholesterol value in mg/dL.
Notes: If multiple HDL samples were collected, the first one should be preferentially abstracted.
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
LDL Cholesterol Value
Coding Instructions: Indicate the LDL cholesterol value in mg/dL.
Notes: If multiple LDL samples were collected, the first one should be preferentially abstracted.
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Triglycerides Cholesterol Value
Coding Instructions: Indicate the triglycerides cholesterol value in mg/dL.
Notes: If multiple triglyceride samples were collected, the first one should be preferentially
abstracted.
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Urine Protein Date and Time
Coding Instructions: Indicate the date and time when the urine protein levels were collected
(not the date results reported).
Target Value: Any occurrence between the first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from VIRGO registry
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Urine Protein Value
Coding Instructions: Indicate the value of urine protein levels.
Target Value: Any occurrence between the first medical contact and discharge
Selections: (1) Positive/ +, (2) Negative, (3) Trace (+/-), (4)++, (5) +++, (6) ++++
Supporting Definition: (none)
Source: Adapted from VIRGO registry
Initial INR Date and Time
Coding Instructions: Indicate the date and time when the initial INR levels were collected (not
the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial INR Value
Coding Instructions: Record the first available INR value.
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial APTT Date and Time
Coding Instructions: Indicate the date and time when the initial APTT levels were collected (not
the date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial APTT Value
Coding Instructions: Record the first available APTT value in seconds.
Target Value: First value between first medical contact and discharge
Selections: (none)
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Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial PT Date and Time
Coding Instructions: Indicate the date and time when the initial PT levels were collected (not the
date results reported).
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Initial PT Value
Coding Instructions: Record the first available PT value in seconds.
Target Value: First value between first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
HBsAg
Coding Instructions: Indicate if the patient was tested for HBsAg antigen or Pre-S1 protein.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
If Yes, specify the result:
Negative
Positive
Un collected
Supporting Definition: HBsAg is the surface antigen of the hepatitis B virus (HBV). It indicates
current hepatitis B infection.
Source: Definition per CORE team
HBsAb
Coding Instructions: Indicate if the patient was tested for HBsAb.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
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If Yes, specify the result:
Negative
Positive
Un collected
Note: If the numerical value is given, please report it.
Supporting Definition: HBsAb is the antibody directed against the surface antigen of the
hepatitis B virus (HBV).
Source: Definition per CORE team
HBeAg /Anti HBeAg
Coding Instructions: Indicate if the patient was tested for HBeAg antigen or Anti-HBeAg
antibody.
Target Value: Any occurrence between arrival at admitting hospital and discharge.
Selections: (1) No (2) Yes
If Yes, specify the result:
Negative
Positive
Un collected
Supporting Definition: HBeAg is an antigen of the hepatitis B virus indicating active replication of
virus in the bloodstream. It indicates current hepatitis B infection.
Source: Definition per CORE team
HCV-Ab
Coding Instructions: Indicate if the patient was tested for HCV antibody.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
If Yes, specify the result:
Negative
Positive
Un collected
Supporting Definition: HCV antibody test helps to detect infection with Hepatitis C virus. If
tested for HCV-IgM, HCV-IgG, or both, the answer is Yes.
Source: Definition per CORE team
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HIV Ab
Coding Instructions: Indicate if the patient was tested for HIV antibody.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
If Yes, specify the result:
Negative
Positive
Un collected
Supporting Definition: HIV antibody test helps to detect infection with Human Immunodeficiency
Virus.
Source: Definition per CORE team
Initial CRP Date and Time
Coding Instructions: Indicate the date and time when the initial CRP levels were collected (not
the date results reported).
Target Value: First occurrence between the first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial CRP Value
Coding Instructions: Indicate the result of test for initial CRP.
Target Value: First occurrence between the first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Unit of CRP/hs-CRP
Coding Instructions: indicate the unit of CRP or hs-CRP.
Target Value: N/A
Selections: (1) Mg/dl (2) Pg/mL (3) Other
Supporting Definition: (none)
Source: Definition per CORE team.
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Initial hs-CRP Date and Time
Coding Instructions: Indicate the date and time when the initial hs-CRP levels were collected
(not the date results reported).
Target Value: First occurrence between the first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
Initial hs-CRP Value
Coding Instructions: Indicate the result of test for initial hs-CRP.
Target Value: First occurrence between the first medical contact and discharge
Selections: (none)
Supporting Definition: (none)
Source: Definition per CORE team
MEDICATIONS ADMINISTERED
Note: All the information about medications was entered into a central medication database. For
each medication, we abstracted name, dose, and route of administration. The following
definitions describe specific pre-defined questions pertinent to medication administration for
acute myocardial infarction.
Aspirin in the First 24 Hours
Coding Instructions: Indicate if aspirin was administered in the first 24 hours before or after first
medical contact, regardless of location of care (e.g. transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Documented Reasons for Non-prescription of Aspirin in the First 24 Hours
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
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the medication in the first 24 hours.
Selections:
(1) No
(2) Yes – Allergy
(3) Yes – Other (specify)
Source: Definition per CORE team
Aspirin in the First 24 Hours- Start Date
Coding Instructions: Indicate the date that aspirin was administered in the first 24 hours before
or after first medical contact, regardless of location of care (e.g. transferring facility or EMS). If
administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact.
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Aspirin in the First 24 Hours- Start Time
Coding Instructions: Indicate the time that aspirin was administered in the first 24 hours before
or after first medical contact, regardless of location of care (e.g. transferring facility or EMS). If
administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Aspirin at Discharge
Coding Instructions: Indicate if aspirin was continued or prescribed.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
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Source: Adapted from AHA Get with the Guidelines ACTION registry
Aspirin at Discharge–Dose
Coding Instructions: Indicate the dose of aspirin prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Documented Reasons for Non-Prescription of Aspirin at Discharge
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
the medication at discharge.
Selections:
(1) No
(2) Yes – Allergy
(3) Yes – Other (specify)
Source: Definition per CORE team
Warfarin during the First 24 Hours
Coding Instructions: Indicate if warfarin was administered in the first 24 hours before or after first
medical contact, regardless of location of care (e.g. transferring facility or EMS).
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence
between 24 hours before first medical contact and 24 hours after first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
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Warfarin at Discharge
Coding Instructions: Indicate if Warfarin was continued or prescribed.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Clopidogrel in the First 24 Hours
Coding Instructions: Indicate if clopidogrel was administered, regardless of location of care (e.g.
transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Clopidogrel in the First 24 Hours- Start Date
Coding Instructions: Indicate the date the initial dose of clopidogrel was administered,
regardless of location of care (e.g. transferring facility or EMS). If administered more than once,
code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact.
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Clopidogrel in the First 24 Hours- Start Time
Coding Instructions: Indicate the time that clopidogrel was administered in the first 24 hours
before or after first medical contact, regardless of location of care (e.g. transferring facility or
EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value for clopidogrel in First 24 Hours Start Date
Selections: (none)
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Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Clopidogrel in the First 24 Hours- Dose
Coding Instructions: Indicate the cumulative dose of clopidogrel.
Target Value: The cumulative dose between first medical contact and 24 hours after first
medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Clopidogrel at Discharge
Coding Instructions: Indicate if clopidogrel was continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Clopidogrel at Discharge–Dose
Coding Instructions: Indicate the dose of clopidogrel prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Ticlopidine in the First 24 Hours
Coding Instructions: Indicate if ticlopidine was administered, regardless of location of care (e.g.
transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
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Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Ticlopidine in the First 24 Hours-Start Date
Coding Instructions: Indicate the date the initial dose of ticlopidine was administered, regardless
of location of care (e.g. transferring facility or EMS). If administered more than once, code the
first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Ticlopidine in the First 24 Hours- Start Time
Coding Instructions: Indicate the time that ticlopidine was administered in the first 24 hours
before or after first medical contact, regardless of location of care (e.g. transferring facility or
EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Ticlopidine in the First 24 Hours- Dose
Coding Instructions: Indicate the cumulative dose of ticlopidine.
Target Value: The cumulative dose between first medical contact and 24 hours after first
medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Ticlopidine at Discharge
Coding Instructions: Indicate if ticlopidine was continued or prescribed at discharge.
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Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Ticlopidine at Discharge –Dose
Coding Instructions: Indicate the dose of ticlopidine prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Prasugrel in the First 24 Hours
Coding Instructions: Indicate if prasugrel was administered, regardless of location of care (e.g.
transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Prasugrel in the First 24 Hours- Start Date
Coding Instructions: Indicate the date the initial dose of prasugrel was administered, regardless
of location of care (e.g. transferring facility or EMS). If administered more than once, code the
first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
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Prasugrel in the First 24 Hours- Start Time
Coding Instructions: Indicate the time that prasugrel was administered in the first 24 hours
before or after first medical contact, regardless of location of care (e.g. transferring facility or
EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Prasugrel in the First 24 Hours- Dose
Coding Instructions: Indicate the cumulative dose of prasugrel.
Target Value: The cumulative dose between first medical contact and 24 hours after first
medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Prasugrel at Discharge
Coding Instructions: Indicate if prasugrel was continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Prasugrel at Discharge–Dose
Coding Instructions: Indicate the dose of prasugrel prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
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Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Fibrinolysis in the First 24 Hours
Coding Instructions: Indicate if fibrinolytics were administered, regardless of location of care
(e.g. transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: If fibrinolytics are used, please name the fibrinolytic agent, the Bolus
dose (IU), the Second Bolus dose (IU/hour), or Maintenance dose (IU/hour), where applicable,
or mark “Unknown” if doses are not documented.
Source: Adapted from VIRGO registry
Refusal of Fibrinolysis
Coding Instructions: Indicate if there is documentation of patient refusal for fibrinolysis
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Fibrinolysis in the First 24 Hours –Start Date
Coding Instructions: Indicate the date the initial dose of fibrinolytic administered, regardless of
location of care (e.g. transferring facility or EMS). If administered more than once, code the first
date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Fibrinolysis in the First 24 Hours –Start Time
Coding Instructions: Indicate the time that a fibrinolytic was administered in the first 24 hours
before or after first medical contact, regardless of location of care (e.g. transferring facility or
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EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Documented Reasons for Non-prescription of Fibrinolysis in the First 24 Hours
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
the medication in the first 24 hours.
Selections: (1) No (2) Yes – Allergy (3) Yes – Other (specify)
Source: Definition per CORE team
Fibrinolysis after the First 24 Hours
Coding Instructions: Indicate if fibrinolytics were administered, regardless of location of care
(e.g. transferring facility or EMS).
Target Value: Any occurrence after the first 24 hours from the first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Fibrinolysis after the First 24 Hours–Start Date
Coding Instructions: Indicate the date the initial dose of fibrinolytic was administered, regardless
of location of care (e.g. transferring facility or EMS). If administered more than once, code the
first date/time it was administered.
Target Value: The first value after the first 24 hours from the first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Fibrinolysis after the First 24 Hours –Start Time
Coding Instructions: Indicate the time that a fibrinolytic was administered in the first 24 hours
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before or after first medical contact, regardless of location of care (e.g. transferring facility or
EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value after the first 24 hours from the first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Anticoagulant Use
Coding Instructions: First, please indicate if an anticoagulant is being used or not (YES/ NO).
Next, please specify the type of anticoagulant(s) administered, including: unfractionated
heparin, low molecular weight heparins (enoxaparin, dalteparin, or fondaparinux), direct
thrombin inhibitors (such as lepirudin, bivalirudin, and argatroban), and coumarins. Please
indicate the start date and time of first administration of the anticoagulant medication(s).
For anticoagulants that are used in the first 24 hours from first medical contact, depending on
the type of the anticoagulant, please also specify:
(1) Was a bolus used? If yes, provide the date, time and dose.
(2) Was an infusion used? If yes, provide the date, time and dose.
(3) Was a subcutaneous injection used? If yes, provide the date, time and dose.
(4) Provide the number of daily injections where applicable.
Source: Adapted from VIRGO registry
Documented Reasons for Non-prescription of Anticoagulants
Coding Instructions: Indicate if the patient has documented reasons for not being prescribed
anti-coagulant medications as described above.
Target Value: N/A
Selections: (1) Yes allergy (2) Yes other (3) No
Supporting Definitions: (none)
Source: Definition per CORE team
Glycoprotein IIb/IIIa Inhibitor Use
Coding Instructions: First, please indicate if glycoprotein IIb/IIIa inhibitors were used (YES/ NO).
Next please specify the data and time of first administration and the name of drug being used:
abciximab, tirofiban or eptifibatide. If used during the first 24 hours from the time of first medical
contact, please indicate the date and time, as well as bolus and maintenance doses.
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Source: Adapted from VIRGO registry
Documented Reasons for Non-prescription of GP IIB/IIIA Inhibitors
Coding Instructions: Indicate if the patient has documented reasons for not being prescribed of
GP IIB/IIIA Inhibitors.
Target Value: N/A
Selections: (1) Yes allergy (2) Yes other (3) No
Supporting Definitions: (none)
Source: Definition per CORE team
Beta-blockers in the First 24 Hours
Coding Instructions: Indicate if a beta-blocker was administered, regardless of location of care
(e.g., transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Beta-blockers in the First 24 Hours- Start Date
Coding Instructions: Indicate the date the initial dose of beta-blocker was administered,
regardless of location of care (e.g. transferring facility or EMS). If administered more than once,
code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Beta Blockers in the First 24 Hours-Start Time
Coding Instructions: Indicate the time that the beta blocker was administered in the first 24
hours before or after first medical contact, regardless of location of care (e.g., transferring facility
or EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
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first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Beta Blockers in the First 24 Hours- Route of Administration
Coding Instructions: Indicate if beta blockers were given intravenous, PO, or both.
Target Value: N/A
Selections: (1) IV (2) PO (3) Both
Supporting Definitions: (none)
Source: Definition per CORE team
Documented Reasons for Non-prescription of Beta-blocker in the First 24 Hours
Coding Instructions: Indicate if the patient has documented reasons for not being prescribed
Beta-blocker in the first 24 hours.
Target Value: N/A
Selections: (1)Yes allergy (2)Yes other (3)No
Supporting Definitions: (none)
Note(s): Code 'yes' if there is documented reason that the patient was started on an oral form of
a beta-blocker within the first 24 hours.
Code 'no' if a there is no documented reason that the patient was given a sublingual, IV, or short
acting formula of one of these medications within the first 24 hours.
Source: Adapted from AHA Get with the Guidelines CATH-PCI registry
Beta Blockers at Discharge
Coding Instructions: Indicate if a beta blocker was continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Beta Blockers at Discharge–Dose
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Coding Instructions: Indicate the dose of beta blockers prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Documented Reasons for Non-prescription of Beta Blockers at Discharge
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
the medication at discharge.
Selections: (1) No (2) Yes – Allergy (3) Yes – Other (specify)
Source: Definition per CORE team
Angiotensin Converting Enzyme Inhibitor in the First 24 Hours
Coding Instructions: Indicate if an angiotensin converting enzyme inhibitor was administered,
regardless of location of care (e.g., transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Angiotensin Converting Enzyme Inhibitors in the First 24 Hours- Start Date
Coding Instructions: Indicate the date the initial dose of angiotensin converting enzyme inhibitor
was administered, regardless of location of care (e.g. transferring facility or EMS). If
administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact.
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
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Angiotensin Converting Enzyme Inhibitors in the First 24 Hours- Start Time
Coding Instructions: Indicate the time that the angiotensin converting enzyme inhibitor was
administered in the first 24 hours before or after first medical contact, regardless of location of
care (e.g. transferring facility or EMS). If administered more than once, code the first date/time it
was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Angiotensin Converting Enzyme Inhibitors in the First 24 Hours- Route of administration
Coding Instructions: Indicate if angiotensin converting enzyme inhibitors were given
intravenous, PO, or both.
Target Value: N/A
Selections: (1) IV (2) PO (3) Both
Supporting Definitions: (none)
Source: Definition per CORE team
Angiotensin Converting Enzyme Inhibitors at Discharge
Coding Instructions: Indicate if an angiotensin converting enzyme inhibitor was continued or
prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Angiotensin Converting Enzyme Inhibitors at Discharge –Dose
Coding Instructions: Indicate the dose of angiotensin converting enzyme inhibitor prescribed at
discharge. The name of the agent used should also be mentioned.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
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"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Documented Reasons for Non-prescription of ACE Inhibitors at Discharge
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
the medication at discharge.
Selections: (1) No (2) Yes – Allergy (3) Yes – Other (specify)
Source: Definition per CORE team
Angiotensin Receptor Blocker in the First 24 Hours
Coding Instructions: Indicate if an angiotensin receptor blocker was administered, regardless of
location of care (e.g. transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Angiotensin Receptor Blockers in the First 24 Hours- Start Date
Coding Instructions: Indicate the date the initial dose of angiotensin receptor blocker was
administered, regardless of location of care (e.g. transferring facility or EMS). If administered
more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact.
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Angiotensin Receptor Blockers in the First 24 Hours- Start Time
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Coding Instructions: Indicate the time that the angiotensin receptor blocker was administered in
the first 24 hours before or after first medical contact, regardless of location of care (e.g.,
transferring facility or EMS). If administered more than once, code the first date/time it was
administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Angiotensin Receptor Blockers at Discharge –Dose
Coding Instructions: Indicate the dose of angiotensin receptor blocker prescribed at discharge.
The name of the agent used should also be mentioned.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Angiotensin Receptor Blockers at Discharge
Coding Instructions: Indicate if an angiotensin receptor blocker was continued or prescribed at
discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Documented Reasons for Non-prescription of ARBs at Discharge
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
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the medication at discharge.
Selections: (1) No (2) Yes – Allergy (3) Yes – Other (specify)
Source: Definition per CORE team
Statin in the First 24 Hours
Coding Instructions: Indicate if a statin was administered, regardless of location of care (e.g.
transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Statins in the First 24 Hours- Start Date
Coding Instructions: Indicate the date the initial dose of statin was administered, regardless of
location of care (e.g. transferring facility or EMS). If administered more than once, code the first
date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact.
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Statins in the First 24 Hours- Start Time
Coding Instructions: Indicate the time that the statin was administered in the first 24 hours
before or after first medical contact, regardless of location of care (e.g., transferring facility or
EMS). If administered more than once, code the first date/time it was administered.
Target Value: The first value between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Statins at Discharge
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Coding Instructions: Indicate if a statin was continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Documented Reasons for Non-Prescription of Statin at Discharge
Coding Instructions: If the medication was not prescribed, indicate whether the reason was
documented.
Target Value: Any documentation in the chart regarding contraindications for the prescription of
the medication at Discharge.
Selections:
(1) No
(2) Yes – Allergy
(3) Yes – Other (specify)
Source: Definition per CORE team
Statin at Discharge –Dose
Coding Instructions: Indicate the dose of statin prescribed at discharge. The agent used should
be named, too.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: The highest value on discharge
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Non-statin Lipid Lowering Agents in the First 24 Hours
Coding Instructions: Indicate if a non-statin lipid-lowering drug was administered, regardless of
location of care (e.g. transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
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Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Non-statin Lipid Lowering Agents at Discharge
Coding Instructions: Indicate if a non-statin lipid-lowering agent was continued or prescribed at
discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Nitrates in the First 24 Hours
Coding Instructions: Indicate if a nitrate was administered, regardless of location of care (e.g.
transferring facility or EMS).
Target Value: Any occurrence between 24 hours before first medical contact and 24 hours after
first medical contact
Selections: (1) No (2) Yes - If yes, name the drug.
Supporting Definitions: (none)
Source: Definition per CORE team
Nitrate at Discharge
Coding Instructions: Indicate if a nitrate was continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes - If yes, name the drug and the dose at discharge
Supporting Definitions: (none)
Source: Definition per CORE team
Ranolazine at Discharge
Coding Instructions: Indicate if ranolazine was continued or prescribed at discharge.
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Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Calcium Channel Blockers at Discharge
Coding Instructions: Indicate if a calcium channel blocker was continued or prescribed at
discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes - If yes, please name the agent being prescribed.
Supporting Definitions: (none)
Source: Definition per CORE team
Traditional Chinese Medications (TCM) at Discharge
Coding Instructions: Indicate if a TCM was continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge
Selections: (1) No (2) Yes -If yes, please name the drug.
Supporting Definitions: (none)
We will note the following seven categories TCPM (traditional Chinese patent medication)
commonly used for AMI in China based on their main ingredient.
1. Danshen or Ginseng or Red Ginseng 2. Ginkgo 3. Sanqi (Panax notoginseng) 4.
Hirudin 5. Erigeron breviscapus Extract(Dengzhan Hua) 6. Lipid-lowing TCPM
(Xuezhikang and Taizhian) 7. Others(Jiuxinwan and Gegengsu)
Source: Definition per China team
Proton Pump Inhibitor Use
Coding Instructions: Indicate if a proton pump inhibitor was administered, regardless of location
of care (e.g. transferring facility or EMS).
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Target Value: Any occurrence the first medical contact and discharge date.
Selections: (1) No (2) Yes - If yes, name the agent being used.
Supporting Definitions: (none)
Source: Definition per CORE team
Other Drugs at Discharge
Coding Instructions: Indicate if other drugs continued or prescribed at discharge.
Note(s): Discharge medications do not need to be recorded for patients who were discharged to
"Other acute care hospital", "Hospice", or "Left against medical advice (AMA)."
Target Value: Any occurrence on discharge.
Selections: (1) No (2) Yes - If yes, please name the agent.
Supporting Definitions: If multiple “other drugs” are used, please report each, separately
Source: Definition per CORE team
Drug allergy
Coding Instructions: Indicate if the patient has any drug allergy
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
CARDIAC CATHETERIZATION AND RELATED COMPLICATIONS
Diagnostic Catheterization or Diagnostic Coronary Angiography
Coding Instructions: Indicate if the patient had a diagnostic coronary angiography procedure.
Target Value: Any occurrence between arrival at first facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: Diagnostic coronary angiography is defined as the passage of a catheter
into the aortic root or other great vessels for the purpose of angiography of the native coronary
arteries or bypass grafts supplying native coronary arteries.
Source: NCDR; adapted from AHA Get with the Guidelines ACTION registry
Reason for Coronary Angiography
Coding Instructions: Indicate the circumstances or leading to coronary angiography
Target Value: N/A
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Selections: (1) Elective (2) Urgent (3) Emergency (4) Salvage (5) Unrecorded
Supporting Definition: This should be performed for 1st 2 occurrences of coronary angiography
Source: Definition per CORE team
Catheterization Laboratory Arrival Date and Time
Coding Instructions: Indicate the date the patient arrived to the cath lab, as documented in the
medical record, as well as the time of arrival
Target Value: The first value between arrival at this facility and discharge
Selections: (none)
Supporting Definitions: Indicate the time (hours: minutes) using the military 24-hour clock,
beginning at midnight (0000 hours). If an arterial sheath is already in place, use the time of the
introduction of a catheter or the time the sheath was exchanged.
Source: Adapted from AHA Get with the Guidelines ACTION registry and from VIRGO registry
Arterial Access Site
Coding Instructions: Indicate the primary location of percutaneous entry. If more than one entry
site was used, choose the site that was used to perform the majority of the procedure.
Target Value: N/A
Selections: Choose one of the following:
a. Femoral; mark “Femoral” if percutaneous puncture of either femoral artery.
b. Radial; mark “Radial” if percutaneous radial approach.
c. Brachial; mark “Brachial” if either a cutdown or percutaneous puncture of either
brachial artery.
d. Other; mark “Other” if percutaneous entry other than femoral, brachial, or radial
approaches to the cardiovascular system.
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Arterial Dominance
Coding Instructions: Indicate the dominance of the coronary anatomy (whether the posterior
descending artery comes from the right or left vessel system).
Selections: Selection Text Definition
Left dominance is present when the posterior descending artery (PDA) and
posterolateral artery (PLA) arise from the left circumflex artery.
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Right dominance is present when the posterior descending artery (PDA) and
posterolateral artery (PLA) arises from the right coronary artery.
Co-dominance is present when the right coronary artery supplies the posterior
descending artery (PDA) and the circumflex supplies the posterolateral artery (PLA).
Thus, there is approximately equal contribution to the inferior surface of the left ventricle
from both the left circumflex and right coronary arteries.
If not reported, select “unrecorded”.
Supporting Definitions: (none)
Source: NCDR; Adapted from the CathPCI registry
Stenosis Percent
Coding Instructions: Indicate the best estimate of most severe percent stenosis in any coronary
artery.
Target Value: The highest value between arrival at first facility and discharge
Selections: Include:
a. Left Main Artery (LM)
b. Proximal LAD
c. Mid/Distal LAD, Diag Branches
d. CIRC, OMs, LPDA and LPL Branches
e. RCA, RPDA, RPL, AM Branches
f. Ramus
Supporting Definitions: Does not include collateral circulation.
Provide the most severe stenosis for the vessel that is primarily providing perfusion to the
myocardium in that territory. (Ex. If a patient's mid LAD is 100% and a graft provides
revascularization to that territory of the heart, code the % stenosis of the graft. If the same
patient has an open graft, and a 70% stenosis of the 2nd diagonal, code 70% since that is the
most severe stenosis % for that territory of the myocardium.) In instances where multiple lesions
are present, enter the single highest percent stenosis noted. If no stenosis, then enter 0%.
Stenosis: Stenosis represents the percentage diameter reduction, from 0 to 100, associated
with the identified vessels. 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.
Source: NCDR; Adapted from AHA Get with the Guidelines ACTION registry
Percent stenosis not available
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Coding Instructions: Indicate if best estimate of percent stenosis is not available.
Target Value: as below
Selections: Left Main artery (LM) not available (1) No (2) Yes
a. Proximal LAD not available (1) No (2) Yes
b. Mid/Distal LAD, Diag Branches not available (1) No (2) Yes
c. CIRC, OMs, LPDA and LPL Branches not available (1) No (2) Yes
d. RCA, RPDA, RPL, AM Branches not available (1) No (2) Yes
e. Ramus not available (1) No (2) Yes
Graft Percent Stenosis
Coding Instructions: Indicate if the percent stenosis is available for the bypass grafts
Target Value: as below
Selections:
a. Graft to Proximal LAD
b. Graft to Mid/Distal LAD, Diag Branches
c. Graft to Circ, OMs, LPDA and LPL Branches
d. Graft to RCA, RPDA, RPL, AM Branches
e. Graft to Ramus
f. None of the Above is Recorded
g. LIMA
h. RIMA
i. SVG
Source: Definition per CORE team modified from NCDR Cath PCI Registry.
Graft Stenosis Percent
Coding Instructions: Indicate the best estimate of most severe percent stenosis in a graft as
determined by angiography. If no stenosis, enter 0%.
Notes: If CABG was performed prior to cardiac catheterization, provide details per each bypass
graft. Leave blank if CABG Date is greater than Procedure Date/Time or Prior CABG is "No".
Target value: N/A
Supporting definition: Stenosis: Stenosis represents the percentage diameter reduction,
ranging from 0 to 100, associated with the identified vessels. Percent stenosis at its maximal
point is estimated to be the amount of reduction in the diameter of the "normal" reference vessel
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proximal to the lesion. In instances where multiple lesions are present, enter the single highest
percent stenosis noted.
Source: Definition per CORE team modified from NCDR Cath PCI Registry.
Graft Stenosis Location
Coding Instructions: Indicate the location of the lesion within the graft.
Target Value: N/A
Selections: (1) Proximal (2) Mid (3) Distal (4) Unrecorded
Supporting Definitions:
Proximal graft site indicates the site of anastomosis closest to the aorta.
Mid-graft site indicates the lesion within the body of the graft.
Distal graft site indicates the site of anastomosis closest to the coronary vessel.
Source: CORE Team
Is the Left Main Stem Protected?
Coding Instructions: Indicate if the patient has protected left main stem disease
Target Value: Any occurrence between beginning of procedure and prior to intervention
Selections: (1) No (2) Yes
Supporting Definitions: Protected left main stem disease implies that the patient has at least
one patent graft on the left anterior descending artery
Source: Definition per CORE team. Lee MS, Faxon DP. Revascularization of left main coronary
artery disease. Cardiol Rev. 2011; 19: 177-83.
Lesion Length
Coding Instructions: Indicate the length of the treated lesion in millimeters.
Note(s): Information obtained after the baseline angiogram can be used to help determine lesion
length (e.g. for total occlusions where the distal vessel cannot be visualized).
Target Value: Any occurrence on current procedure
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
Characteristics of the Lesion
Coding Instructions: Indicate the characteristics that apply for the lesion.
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Target Value: N/A
Selections: (1) Thrombus Present in Lesion (2) Bifurcation Lesion (3) Calcified Lesion (4) Type
A Lesion (5) Type B Lesion (6) Type C Lesion (7) None of the Above is Recorded
Supporting Definitions:
Bifurcation Lesion - A significant bifurcation or branch point is a division of a vessel into at least
two branches, each of which is >1.5 mm or greater in diameter. In a bifurcation or branch lesion,
the plaque extends from at least one of the limbs to the branch point; it need not progress down
all the proximal and distal branches. Bifurcations or branch point lesions should be considered
one lesion, no matter how many limbs are treated.
Calcified Lesion – Indicate if there is any calcification within the lesion.
Type A lesions include the following characteristics: Discrete (<10 mm length), Concentric,
Readily accessible, Non-angulated segment <45 degrees, Smooth contour, Little or no
calcification, Less than totally occlusive, Not ostial in location, No major branch involvement,
Absence of thrombus
Type B lesions include the following characteristics: Tubular (10-20 mm length), Eccentric,
Moderate tortuosity of proximal segment, Moderately angulated segment, 45-90 degrees,
Irregular contour, Moderate to heavy calcification, Ostial in location, Bifurcation lesions requiring
double guidewires
Some thrombus present, Total occlusion <3 months old
Type C lesions include the following characteristics: Diffuse (length > 2cm), Excessive tortuosity
of proximal segment, Extremely angulated segments > 90 degrees, Total occlusions > 3
months old and/or bridging collaterals, Inability to protect major side branches, Degenerated
vein grafts with friable lesions
Source: Adapted from NCDR CathPCI
Type of Contrast Dye Used
Coding Instructions: Indicate the name of radiographic contrast agent used for angiography.
Target Value: N/A
Selections: Urografin, Iopamidol , Iopromide , Iohexol , Iodixanol , Iomeprol , Ioversol , Other,
Unrecorded.
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Total Volume of Contrast Dye Used
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Coding Instructions: Indicate the total volume (ml) of contrast dye used during angiography/PCI.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Complication- Contrast Reaction
Coding Instructions: Indicate whether patient experienced a contrast reaction during the cath lab
visit or after the lab visit but before discharge.
Target Value: Any occurrence between PCI and discharge
Selections: (1) No (2) Yes
Supporting Definition: Contrast reaction is defined as at least one of the following:
a. Anaphylaxis-including bronchospasm and/or vascular collapse
b. Urticaria
c. Hypotension-prolonged depression of blood pressure below 70mm Hg.
Source: Adapted from VIRGO registry
Fractional Flow Reserve
Coding Instructions: Indicate if fractional flow reserve was performed to confirm the percent
stenosis. Myocardial fractional flow reserve is a lesion-specific index of stenosis severity.
Target Value: Any occurrence between beginning of procedure and prior to intervention
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
Fractional Flow Reserve Ratio
Coding Instructions: indicate the fractional flow reserve ratio.
Target Value: The lowest value between beginning of procedure and prior to intervention
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
Intravascular Ultrasound (IVUS)
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Coding Instructions: Indicate if intravascular ultrasound was performed to confirm the percent
stenosis.
Target Value: Any occurrence between beginning of procedure and prior to intervention
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: NCDR CathPCI
Left Ventricular Ejection Fraction Measured During Procedure
Coding Instructions: Indicate whether the left ventricular ejection fraction was measured during
the catheterization procedure.
Target Value: N/A
Selections: (1) No (2) Yes, EF = ______%
Supporting Definitions: (none)
Source: Definition per CORE team.
Recommendation (After Diagnostic Catheterization)
Coding Instructions: Indicate the recommendations after diagnostic catheterization.
Target Value: N/A
Selections: (1) Medical therapy/counseling (2) PCI without planned CABG (3) CABG (including
planned hybrid procedures) (4) Other cardiac therapy without CABG or PCI (5) None.
Supporting Definitions: (none)
Source: Definition per CORE team
Was PCI Performed Immediately Following Diagnostic Catheterization?
Coding Instructions: Indicate if PCI was performed immediately after diagnostic catheterization.
Target Value: Any occurrence between beginning of procedure and prior to intervention.
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
PCI Date and Time
Coding Instructions: Indicate the date and time the procedure(s) was/were initiated.
Note(s): Indicate the date (mm/dd/yyyy) and time (hours: minutes) using the military 24-hour
clock, beginning at midnight (0000 hours).
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If an arterial sheath is already in place, use the time of the introduction of a catheter or the time
the sheath was exchanged.
Target Value: N/A
Selections: (none)
Supporting Definitions: Time of Procedure: The time the procedure started is defined as the time
at which local anesthetic was first administered for vascular access, or the time of the first
attempt at vascular access for the cardiac catheterization (use whichever is earlier).
Source: Adapted from NCDR CathPCI
Blood Pressure Prior to PCI
Coding Instructions: Indicate the blood pressure prior to the PCI procedure.
Target Value: The last available value prior to the start of the PCI procedure.
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Heart Rate Prior to PCI
Coding Instructions: Indicate the heart rate recorded prior to the PCI procedure.
Target Value: The last available value prior to the start of the PCI procedure.
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Cardiogenic Shock at the Start of PCI
Coding Instructions: Indicate if cardiogenic shock was documented at the start of PCI.
Target Value: Any occurrence at the start of the PCI procedure.
Selections: (1) No (2) Yes
Supporting Definitions: Physician documentation of cardiogenic shock.
Source: Definition per CORE team.
Pre-Procedure TIMI Flow
Coding Instructions: Indicate the pre-procedure TIMI flow value.
Note(s): If a lesion spans multiple segments with different TIMI flows, code the lowest TIMI flow
within the entire lesion.
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Selections:
TIMI - 0 No flow/no perfusion
TIMI - 1 Slow penetration without perfusion
TIMI - 2 Partial flow/partial perfusion (greater than TIMI-1 but less than TIMI-3).
TIMI - 3 Complete and brisk flow/complete perfusion.
Unknown/not reported
Target Value: Any occurrence on current procedure
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
Percutaneous Coronary Intervention (PCI)
Coding Instructions: Indicate if the patient had percutaneous coronary intervention
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: Percutaneous coronary intervention (PCI) is the placement of an
angioplasty guide wire, balloon, or other device (e.g. stent, atherectomy, brachytherapy, or
thrombectomy catheter) into a native coronary artery or coronary artery bypass graft for the
purpose of mechanical coronary revascularization.
Source: Adapted from AHA Get with the Guidelines ACTION registry
Refusal of Percutaneous Coronary Intervention
Coding Instructions: Indicate if there is documentation of patient refusal for percutaneous
coronary intervention
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Previously Treated Lesion
Coding Instructions: Indicate if the lesion of interest had been treated before
Target Value: Any occurrence between birth and current procedure.
Selections: (1) No (2) Yes (3) Unknown/not reported
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
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Treated with Stent
Coding Instructions: Indicate if the previously treated lesion was treated with any type of stent in
the current or prior episode of care.
Target Value: Any occurrence between birth and current procedure
Selections: (1) No (2) Yes (3) Unknown/not reported
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
Reasons for PCI at the Site of Former Stent
Coding Instructions: Indicate the reasons for performing PCI at a previously treated site.
Target Value: N/A
Selections: (1) In-Stent Restenosis (2) In-Stent Thrombosis (3) Unrecorded
Supporting Definitions:
In-stent restenosis is defined as a previously stented lesion that has 50% or greater stenosis.
In-stent thrombosis is defined as presence of thrombus in a stent.
Source: CORE Team
Did Guidewire Cross Lesion?
Coding Instructions: Indicate if the guidewire successfully crossed the lesion.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
First Device Activation Date and Time
Coding Instructions: Indicate the date and time the first device was activated regardless of type
of device used.
Note(s): Use the earliest time from the following:
1. Time of the first balloon inflation.
2. Time of the first stent deployment.
3. Time of the first treatment of lesion (AngjoJet or other thrombectomy/aspiration
device, laser, rotational atherectomy).
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4. If the lesion cannot be crossed with a guidewire or device (and thus none of the above
apply), use the time of guidewire introduction.
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.
Indicate the time (hours:minutes) using the military 24-hour clock, beginning at midnight
(0000 hours).
This element is referenced in The Joint Commission AMI Core Measures AMI-8, AMI-8a.
Target Value: N/A
Selections: (none)
Supporting Definitions: Indicate the time (hours: minutes) using the military 24-hour clock,
beginning at midnight (0000 hours).
Source: Adapted from AHA Get with the Guidelines CATH-PCI registry
Time of the First Balloon Inflation
Coding Instructions: Indicate the date and time of the first balloon inflation during percutaneous
coronary intervention
Target Value: N/A
Selections: (none)
Supporting Definitions: Indicate the time (hours: minutes) using the military 24-hour clock,
beginning at midnight (0000 hours).
Source: Adapted from VIRGO registry
Time of the First Stent Deployment
Coding Instructions: Indicate the date and time of the first stent deployment during
percutaneous coronary intervention
Target Value: N/A
Selections: (none)
Supporting Definitions: Indicate the time (hours: minutes) using the military 24-hour clock,
beginning at midnight (0000 hours).
Source: Adapted from VIRGO registry
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Stent(s) Placed
Coding Instructions: Indicate if a stent or stents were placed in the affected coronary artery.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Total Number of Stent(s) Placed
Coding Instructions: Indicate the number of stents placed in the affected coronary artery.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Bare Metal Stent Implanted
Coding Instructions: Indicate if one or more bare metal stents were implanted during PCI.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Drug Eluting Stent Implanted
Coding Instructions: Indicate if one or more drug eluting stents were implanted during PCI.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Use of Mechanical Ventricular Support During Catheterization Procedure
Coding Instructions: Indicate if mechanical ventricular support was used during catheterization.
Target Value: Any occurrence between beginning of procedure and prior to intervention
Selections: (1) Intraaortic balloon pump (IABP) (2) extracorporeal membrane oxygenation
(ECMO) (3) Left ventricular assist device (LVAD) (4) None
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Note: if mechanical ventricular support was used, indicate if it was started at the start of the
catheterization, during the catheterization procedure and prior to PCI, or after PCI began.
Supporting Definitions: (none)
Source: Definition per CORE team
Post-Procedure TIMI Flow
Coding Instructions: Indicate the post- procedure TIMI flow value.
Target Value: Any occurrence on current procedure
Note(s): If a lesion spans multiple segments with different TIMI flows, code the lowest TIMI flow
within the entire lesion.
Selections: Selection Text Definition
TIMI - 0 No flow/no perfusion
TIMI - 1 Slow penetration without perfusion
TIMI - 2 Partial flow/partial perfusion (greater than TIMI-1 but less than TIMI-3.
TIMI - 3 Complete and brisk flow/complete perfusion.
Supporting Definitions: (none)
Source: Adapted from NCDR CathPCI
Devices Deployed During Catheterization Procedure
Coding Instructions: Indicate if any intracardiac device was deployed.
Target Value: N/A
Selections: (1) None (2) Balloon (3) Cutting Balloon (4) Rotablator (5) Aspiration Catheters (6)
IVUS (7) Pressure Wire (8) Flowire (9) Brachytherapy (10) Distal/Proximal Embolic Protection
(11) Thrombectomy Device
Supporting Definitions: (none)
Source: Definition per CORE team.
Closure Method
Coding Instructions: Indicate the closure method after percutaneous coronary intervention (PCI).
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections:
a. Seal (Angioseal, Vasoseal)
b. Suture
c. Manual Compression
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d. Other
e. Unrecorded
Supporting Definition: The closure device is a device used at the arterial access site at the end
of the procedure to facilitate hemostasis without need for manual compression.
Source: Adapted from AHA Get with the Guidelines ACTION registry
PCI Complication-Tamponade
Coding Instructions: Indicate if the patient experienced a cardiac tamponade associated with the
cardiac catheterization/PCI.
Target Value: Any occurrence between PCI and discharge
Selections: (1) No (2) Yes
Supporting Definition: Mark “Yes” if there was fluid in the pericardial space compromising
cardiac filling and requiring intervention during the cath lab visit or after lab visit until discharge
(or before any subsequent lab visits). This should be documented by either:
a. Echo showing pericardial fluid and signs of tamponade such as right heart
compromise; or
b. Systemic hypotension due to pericardial fluid compromising cardiac function.
Source: Adapted from VIRGO registry
PCI Complication-Peripheral Embolization
Coding Instructions: Indicate whether patient experienced peripheral embolization after PCI.
Target Value: Any occurrence between PCI and discharge
Selections: (1) No (2) Yes
Supporting Definition: Mark “Yes” if a peripheral embolization occurred distal to the arterial
access site during the procedure or after lab visit but before any subsequent lab visits, requiring
therapy. Peripheral embolization is defined as a loss of distal pulse, pain and/or discoloration
(especially the toes). This can include cholesterol emboli.
Source: Adapted from VIRGO registry
PCI Complication-Access Site Arteriovenous Fistula
Coding Instructions: Indicate whether patient experienced access site arteriovenous fistula
during the cath lab visit or after lab visit until discharge.
Target Value: Any occurrence between PCI and discharge
Selections: (1) No (2) Yes
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Supporting Definition: (none)
Source: Adapted from VIRGO registry
PCI Complication-Access Complication Requiring Surgery/Intervention
Coding Instructions: Indicate whether patient experienced access site occlusion at the site of
percutaneous entry during the procedure or after lab visit but before any subsequent lab visits.
Target Value: Any occurrence between PCI and discharge
Selections: (1) No (2) Yes
Supporting Definition: Access site occlusion if defined as: Total obstruction of the artery usually
by thrombus (but may have other causes) usually at the site of access requiring surgical repair.
Occlusions may be accompanied by absence of palpable pulse or Doppler.
Source: Adapted from VIRGO registry
PCI Complication-Retroperitoneal Bleeding
Coding Instructions: Indicate whether patient experienced retroperitoneal bleeding after lab visit.
Target Value: Any occurrence between PCI and discharge
Selections: (1) No (2) Yes
Supporting Definition: Mark “Yes” if retroperitoneal bleeding occurred during or after the cath lab
visit until discharge. The bleeding should require a transfusion and/or prolong the hospital stay,
and/or cause a drop in hemoglobin > 3.0 gm/dl.
Source: Adapted from VIRGO registry
Repeat PCI
Coding Instructions: Indicate whether patient had a second PCI during hospital stay
Target Value: Any occurrence after first PCI and before discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Adapted from VIRGO registry
Stent Thrombosis
Coding Instructions: Indicate whether patient experienced in-stent thrombosis after PCI
Target Value: Any occurrence after the first PCI and before discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
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Source: Adapted from VIRGO registry
Reasons for Repeat PCI
Coding Instructions: Indicate the reasons for the repeat coronary angiography/ PCI during the
hospital stay.
Selections:
1. Staged procedure
2. Ongoing or recurrent ischemia
3. Other
Target Value: Any occurrence after first PCI and discharge
Supporting Definition: Mark “Staged procedure” if second PCI was planned during
hospitalization for residual stenoses. Mark “Ongoing or recurrent ischemia/angina” if the patient
had recurrent symptoms (e.g. angina), signs (e.g. dynamic ECG changes) or biomarker
elevation consistent with ischemia.
Source: Definition per CORE team and Adapted from VIRGO registry
In-Hospital Implantation of a Permanent Pacemaker Device
Coding Instructions: Indicate if the patient had a permanent pacemaker implanted during the
hospital stay.
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
Supporting Definitions: Permanent pacemaker includes single-chamber, dual chamber, and
biventricular pacemakers. It does not include temporary transcutaneous pacemaker.
Source: Adapted from VIRGO registry
Date of In-Hospital Permanent Pacemaker Device Implantation
Coding Instructions: Indicate date that permanent pacemaker device was placed.
Target Value: The first value between arrival at first facility and discharge
Selections: N/A
Supporting Definition: (none)
Source: Definition per CORE team
In-Hospital Implantation of an Automatic Implantable Cardioverter Defibrillator (AICD)
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Coding Instructions: Indicate whether patient received an implantable cardioverter defibrillator at
any time during hospital stay.
Target Value: N/A
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Date of In-Hospital Automatic Implantable Cardioverter Defibrillator (AICD) Implantation
Coding Instructions: Indicate date that Automatic Implantable Cardioverter Defibrillator was
placed
Target Value: The first value between arrival at first facility and discharge
Selections: N/A
Supporting Definition: (none)
Source: Definition per CORE team
In-Hospital Implantation of a Left-Ventricular Assist Device (LVAD)
Coding Instructions: Indicate whether the patient received an LVAD at any time during the
hospital stay
Target Value: Any occurrence between arrival at admitting hospital and discharge
Selections: (1) No (2) Yes
Supporting Definition: (none)
Source: Definition per CORE team
Date of In-Hospital LVAD Implantation
Coding Instructions: Indicate date that LVAD was placed
Target Value: The first value between arrival at first facility and discharge
Selections: N/A
Supporting Definition: (none)
Source: Definition per CORE team
Coronary Artery Bypass Grafting (CABG)
Coding Instructions: Indicate if the patient had a CABG
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
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Selections: (none)
Supporting Definitions: (none)
Source: Adapted from VIRGO registry
Refusal of Coronary Artery Bypass Grafting
Coding Instructions: Indicate if there is documentation of patient refusal for coronary artery
bypass grafting
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
CABG Date
Coding Instructions: Indicate the date of the coronary artery bypass graft (CABG) surgery.
Target Value: The first value between arrival at this facility and discharge
Selections: (none)
Supporting Definitions: (none)
Source: Definition as per CORE team
SUMMARY OF IN-HOSPITAL EVENTS
In-Hospital Bleeding
Coding Instructions: Indicate if the patient had a bleeding event during hospitalization.
Target Value: Any occurrence mentioned in the chart from arrival to the facility to discharge
Selections: (1) No (2) Yes
Supporting Definitions: If yes, please indicate the time and date.
Source: Definition per CORE team
Location of Bleeding
Coding Instructions: Indicate the location of bleeding.
Target Value: N/A
Selections: (1) Access site (2) Intracranial (3) Intraocular (4) Intraspinal (5) Retroperitoneal (6)
Pericardial (7) Gastrointestinal (8) Genitourinary (9) Other (specify)
Supporting Definitions: Access site bleeding is marked when bleeding happens at the site of
vascular access. Intracranial bleeding includes intracerebral and subdural bleeding. Please
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record each site separately if more than one applies.
Source: Definition per CORE team
Nadir Blood Pressure After Bleeding Event
Coding Instructions: Indicate the value of the lowest recorded blood pressure on the day of or
the next day after bleeding onset.
Target Value: Lowest occurrence of blood pressure between bleeding onset and the next day
Selections: N/A
Supporting Definition: (none)
Source: Definition per CORE team
Hypovolemic/hemorrhagic Shock after Bleeding
Coding Instructions: Indicate if bleeding led to hypovolemic or hemorrhagic shock.
Target Value: Any occurrence during the hospital stay
Selections: (1) No (2) Yes (3) Unknown
Supporting Definitions: In patients who bled during the hospital stay, evidence in the chart may
suggest hypovolemic shock:
A) Physician report of hypovolemic shock in the chart
B) Post-bleeding systolic hypotension (peak systolic pressure<90mmHg) or a
reduction of >40mmHg in systolic blood pressure plus evidence of organ hypoperfusion,
which is not responsive to administration of plasma expanders or packed RBCs.
Source: Definition per CORE team
Interventions for Management of Bleeding
Coding Instructions: Indicate the intervention(s) used to manage bleeding.
Target Value: Any occurrence after the bleeding event.
Selections: (1) whole blood transfusion (2) packed red cell transfusion (3) local compression (4)
surgical intervention, including open surgery, closure or endoscopic interventions (5) other (6)
none (7) unrecorded.
Supporting Definitions: Access site bleeding is marked when bleeding happens at the site of
vascular access. Intracranial bleeding includes intracerebral and subdural bleeding.
Note(s): Please record each intervention separately if more than one was applied.
Source: Definition per CORE team
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Blood Transfusion
Coding Instructions: Indicate if the patient was transfused with whole blood or any of its
components.
Target Value: Any occurrence between first medical contact and discharge
Selections: (1) No (2) Yes (3) Unrecorded
If Yes, specify:
Red blood cell
Platelet
Blood plasma
Whole Blood
Other (specify)______
Supporting Definition: (none)
Source: Definition per CORE team
Bleeding Date Hb, HCT, Platelet Count, PT, aPTT, and INR
Coding Instructions: Indicate the bleeding date Hb, HCT, Platelet Count, PT, aPTT, and INR.
Target Value: In two separate time points
A) Last available laboratory tests before the bleeding event happened
B) Nadir of the aforementioned laboratory tests after the bleeding event
Selections: Varies for each, please refer to the definitions in the laboratory tests section.
Supporting Definitions: Such information should only be collected for patients with bleeding
Source: Definition per CORE team
In-Hospital Dialysis
Coding Instructions: Indicate if the patient received dialysis during the hospital stay
Target Value: Any occurrence from the hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: Yes includes hemodialysis, peritoneal dialysis, or both.
Source: Adapted from VIRGO registry
In-Hospital Cardiac Tamponade
Coding Instructions: Indicate if cardiac tamponade occurred during the hospital stay
Target Value: Any occurrence from the hospital stay to discharge
Selections: (1) No (2) Yes
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Supporting Definitions: A clinical syndrome caused by the accumulation of fluid in the pericardial
space, resulting in reduced ventricular filling and subsequent hemodynamic compromise.
Source: Definition per CORE team
In-Hospital Venous Thromboembolism
Coding Instructions: Indicate if in-hospital venous thromboembolism (VTE) was diagnosed
during the hospital stay
Target Value: Any occurrence from the beginning of the hospital stay to discharge
Selections: (1) No (2) Yes - If yes, please indicate the date
Supporting Definitions: Venous thromboembolism (VTE) is comprised of deep vein thrombosis
([DVT]; i.e. development of blood clots in the deep veins of lower extremity or upper extremity)
and pulmonary embolism ([PE]; i.e. migration of the clots to the pulmonary arteries. The clots
can clog the pulmonary arteries, impairing the gas exchange in the lungs. PE is associated with
symptoms such as dyspnea and chest pain and can be fatal). For any patient that was
diagnosed with DVT, or with PE, or with both during the index admission, please mark “Yes”.
Source: Definition per CORE team
In-Hospital Deep Vein Thrombosis (DVT)
Coding Instructions: Indicate if in-hospital DVT was diagnosed during the hospital stay
Target Value: Any occurrence from the beginning of the hospital stay to discharge
Selections: (1) No (2) Yes - If yes, please indicate the date
Supporting Definitions: DVT refers to development of blood clots in the deep veins of lower
extremity or upper extremity migration of the clots to the pulmonary arteries. The symptoms and
signs include extremity pain, warmness, swelling, a palpable venous cord, and tenderness. The
diagnosis is made by ultrasonography or venography. Mark “Yes” if there is physician
documentation for the diagnosis.
Source: Definition per CORE team
In-Hospital Pulmonary Embolism (PE)
Coding Instructions: Indicate if in-hospital PE was diagnosed during the hospital stay
Target Value: Any occurrence from the beginning of the hospital stay to discharge
Selections: (1) No (2) Yes - If yes, please indicate the date
Supporting Definitions: PE refers to a clinical condition resulting from migration of the clots
(rarely other material) to the pulmonary arteries. The clots can clog the pulmonary arteries,
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impairing the gas exchange in the lungs. PE is associated with symptoms such as dyspnea,
hemoptysis and chest pain and can be fatal. The diagnosis could be made by ventilation-
perfusion (V/Q) scanning, computed tomography pulmonary angiography, or conventional
pulmonary angiography. Mark “Yes” if there is physician documentation for the diagnosis.
Source: Definition per CORE team
In-Hospital Infection
Coding Instructions: Indicate if in-hospital infection occurred during the hospital stay
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes If yes, please indicate the date
Supporting Definitions: (none)
Source: Definition per CORE team
In-Hospital Infection –Site
Coding Instructions: Indicate the site of in-hospital infection
Target Value: N/A
Selections: (1) Pulmonary (2) Genitourinary (3) Gastrointestinal (4) Skin (5) Surgical
site/procedure site (6) Other (7) Site unknown
Supporting Definitions: (none)
Source: Definition per CORE team
In-Hospital Cardiogenic Shock
Coding Instructions: Indicate if cardiogenic shock occurred during the hospital stay
Target Value: Any occurrence from the hospital stay to discharge
Selections: (1) No (2) Yes- If yes, please indicate the date and time
Supporting Definitions: Cardiogenic shock is defined as a sustained (>30 minutes) episode of
systolic blood pressure <90 mm Hg, and/or cardiac index <2.2 L/min/m2 determined to be
secondary to cardiac dysfunction, and/or the requirement for parenteral inotropic or vasopressor
agents or mechanical support (e.g., IABP, extracorporeal circulation, ventricular assist devices)
to maintain blood pressure and cardiac index above those specified levels.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), Adapted from
AHA Get with the Guidelines ACTION registry
In-Hospital Cardiac Rupture
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Coding Instructions: Indicate if there is physician documentation of in-hospital cardiac rupture
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
In-Hospital Recurrent Angina/Recurrent Myocardial Infarction
Coding Instructions: Indicate if there is physician documentation of in-hospital recurrent angina
or recurrent myocardial infarction
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: Physician documentation of recurrent angina, or recurrent myocardial
infarction, or both, warrants a “Yes” answer.
Source: Definition per CORE team
In-Hospital Ventricular Tachycardia/Ventricular Fibrillation
Coding Instructions: Indicate if there is physician documentation of in-hospital ventricular
tachycardia or ventricular fibrillation
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: Physician documentation of ventricular tachycardia or ventricular
fibrillation, or both, warrants a “Yes” answer.
Source: Definition per CORE team
In-Hospital Papillary Muscle Rupture
Coding Instructions: Indicate if there is physician documentation of in-hospital papillary muscle
rupture.
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
In-Hospital Ventricular Septal Perforation
Coding Instructions: Indicate if there is physician documentation of ventricular septal perforation.
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Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Significant Coronary Artery Dissection
Coding Instructions: Indicate if a significant coronary artery dissection was observed.
Note(s): Typically, dissections described as type A or B are not considered significant
dissections because there is no impairment of flow. Significant dissections are grade C
dissections in the presence of ischemia, or grade D-F dissections, all of which are further
described as:
Type C: persisting contrast medium extravasations;
Type D: spiral filling defect with delayed but complete distal flow;
Type E: persistent filling defect with delayed antegrade flow;
Type F: filling defect with impaired flow and total occlusion
The intracoronary device counter is reset back to one for each procedure.
Target Value: Any occurrence on current procedure
Selections: (1) No (2) Yes
Supporting Definitions: Coronary artery dissection is defined as the appearance of contrast
materials outside of the expected luminal dimensions of the target vessel and extending
longitudinally beyond the length of the lesion.
Source: NCDR CathPCI
Coronary Artery Perforation
Coding Instructions: Indicate if angiographic or clinical evidence of coronary artery perforation
was observed.
Note(s): This does not include pre-existing AV fistula and other coronary anomalies.
Target Value: Any occurrence on current procedure
Selections: (1) No (2) Yes
Supporting Definitions: A coronary artery perforation occurs when there is angiographic or
clinical evidence of a dissection or intimal tear that extends through the full thickness of the
arterial wall.
Source: NCDR CathPCI
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Abrupt Vessel Closure in the Catheterization Laboratory
Coding Instructions: Indicate whether there was total occlusion (TIMI grade 0 or 1 flow) of the
dilated coronary artery occurring at any time during the catheterization procedure.
Target Value: N/A
Selections: (none)
Supporting Definitions: (none)
Source: CORE team; Relation between activated clotting time during angioplasty and abrupt
closure. Circulation. 1996 Feb 15;93(4):667-71.
Side Branch Occlusion
Coding Instructions: Indicate whether reduction in TIMI flow to grade 0 or 1 was observed in the
side branch during the catheterization procedure.
Target Value: N/A
Selections: (none)
Supporting Definitions: (none)
Source: CORE team; Frequency and clinical consequences associated with sidebranch
occlusion during stent implantation using zotarolimus-eluting and paclitaxel-eluting coronary
stents. Circ Cardiovasc Interv. 2009 Apr;2(2):133-9. Epub 2009 Apr 1.
Distal Embolization
Coding Instructions: Indicate if angiographic evidence of distal embolization was observed.
Target Value: Any occurrence on current procedure
Selections: (1) No (2) Yes
Supporting Definitions: Angiographic distal filling defect with an abrupt cutoff in at least one of
distal branches or vessels of the infarct related artery at any point during the procedure.
Source: CORE team; Fokkema ML, Vlaar PJ, Svilaas T, et al. Incidence and clinical
consequences of distal embolization on the coronary angiogram after percutaneous coronary
intervention for ST-elevation myocardial infarction. Eur Heart J. 2009; 30: 908-15, Fukuda D,
Tanaka A, Shimada K, Nishida Y, Kawarabayashi T, Yoshikawa J. Predicting angiographic
distal embolization following percutaneous coronary intervention in patients with acute
myocardial infarction. Am J Cardiol. 2003; 91: 403-7, Henriques JP, Zijlstra F, Ottervanger JP,
et al. Incidence and clinical significance of distal embolization during primary angioplasty for
acute myocardial infarction. Eur Heart J. 2002; 23: 1112-7.
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No Flow/Slow flow phenomenon
Coding Instructions: Indicate if angiographic evidence of no flow/ slow flow was observed.
Note(s): This does not include impaired flow due to dissection or thrombus.
Target Value: Any occurrence on current procedure
Selections: (1) No (2) Yes
Supporting Definitions: No flow is defined as cessation of blood flow (or thrombolysis in
myocardial infarction grade ≤ 1flow) into the distal coronary artery in the absence of
angiographic explanation for impairment of flow.
Source: CORE team; Yip HK, Chen MC, Chang HW, et al. Angiographic morphologic features
of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of
slow-flow and no-reflow phenomenon. Chest 2002 ;122: 1322-32 and Matsuo H, Watanabe S,
Watanabe T, et al. Prevention of no-reflow/slow-flow phenomenon during rotational
atherectomy--a prospective randomized study comparing intracoronary continuous infusion of
verapamil and nicorandil. Am Heart J. 2007; 154: 994.e1-6.
Access Site Occlusion
Coding Instructions: Indicate if access site occlusion was observed.
Target Value: Any occurrence on current procedure
Selections: (1) No (2) Yes
Supporting Definitions: Total obstruction of the artery used as the access site. This is typically
due to a thrombus (but may have other causes) and usually requires surgical repair.
Source: CORE team; Rao SV, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes
of radial and femoral approaches to percutaneous coronary intervention: a report from the
National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008; 1: 379-86.
In-Hospital Acute Renal Failure
Coding Instructions: Indicate if there is physician documentation or report of in-hospital acute
renal failure
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: Acute renal failure is defined as physician documentation of acute renal
failure
Source: Definition per CORE team
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In-Hospital Peripheral Embolization
Coding Instructions: Indicate if there is physician documentation or report of in-hospital
peripheral embolization
Target Value: Any occurrence from the beginning of hospital stay to discharge
Selections: (1) No (2) Yes
Supporting Definitions: Peripheral embolization should not be reflected here.
Source: Definition per CORE team
In-Hospital Death
Coding Instructions: Indicate if the patient died during hospital stay.
Target Value: Any occurence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
In-Hospital Death Date
Coding Instructions: Indicate the date of patient’s death.
Target Value: The first value on death date.
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Autopsy
Coding Instructions: Indicate if an autopsy of patient was performed after death.
Target Value: N/A
Selections: (1) No (2) Yes (3) Unrecorded
Supporting Definition: Autopsy is a postmortem examination to discover the cause of death or
the extent of disease
Source: Definition per CORE team; Oxford English Dictionary
In-Hospital Cardiac Arrest
Coding Instructions: Indicate if the patient experienced an episode of cardiac arrest in your
facility.
Target Value: Any occurrence between arrival at this facility and discharge
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Selections: (1) No (2) Yes
Supporting Definitions: 'Sudden' cardiac arrest is the sudden cessation of cardiac activity so that
the victim becomes unresponsive, with no normal breathing and no signs of circulation. If
corrective measures are not taken rapidly, this condition progresses to sudden death. Cardiac
arrest should be used to signify an event as described above that is reversed, usually by CPR,
and/or defibrillation or cardioversion, or cardiac pacing. Sudden cardiac arrest is not the same
as sudden cardiac death. Sudden cardiac death describes a fatal event.
Source: ACC/AHA/HRS 2006 Key Data Elements and Definitions for Electrophysiological
Studies and Procedures
In-Hospital Cardiac Arrest Date
Coding Instructions: Indicate the date of the cardiac arrest.
Target Value: The first value between arrival at this facility and discharge
Selections: (none)
Supporting Definitions: (none)
In-Hospital Cerebrovascular accident (CVA)/Stroke
Coding Instructions: Indicate if the patient experienced a stroke or (CVA) in your facility.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: Stroke: A stroke or Cerebrovascular accident is defined as loss of
neurological function caused by an ischemic or hemorrhagic event with residual symptoms at
least 24 hours after onset or leading to death.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30)
In-Hospital Stroke Date
Coding Instructions: Indicate the date of onset of stroke. If a stroke occurs during sleep, last
awake time may be used.
Target Value: The first value between arrival at this facility and discharge
Selections: (none)
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
In-Hospital Hemorrhagic Stroke
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Coding Instructions: Indicate if the patient experienced a hemorrhagic stroke with
documentation on imaging.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: Hemorrhagic Stroke: A hemorrhagic stroke requires documentation on
imaging (e.g. CT scan or MRI of hemorrhage in the cerebral parenchyma, or a subdural or
subarachnoid hemorrhage). Evidence of hemorrhagic stroke obtained from lumbar puncture,
neurosurgery, or autopsy can also confirm the diagnosis.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30)
In-Hospital Unspecified Stroke
Coding Instructions: Indicate if the patient experienced an unspecified stroke with
documentation on imaging.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: An unspecified stroke can be defined as stroke without documentation
on imaging. Evidence of stroke obtained from clinical symptoms.
Source: Definition per CORE team
In-Hospital (New Onset) Heart Failure
Coding Instructions: Indicate if there is physician documentation or report on development of
heart failure during hospital stay.
Target Value: Any occurrence between first medical contact and arrival at this facility
Selections: (1) No (2) Yes
Supporting Definitions: Heart failure is defined as physician documentation or report of any of
the following clinical symptoms of heart failure described as unusual dyspnea on light exertion,
recurrent dyspnea occurring in the supine position, fluid retention; or the description of rales,
jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest
X-ray presumed to be cardiac dysfunction. A low ejection fraction without clinical evidence of
heart failure does not qualify as heart failure.
Source: Acute Coronary Syndromes Data Standards (JACC 2001 38: 2114 - 30), The Society of
Thoracic Surgeons
In-Hospital Atrial Fibrillation or Flutter
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Coding Instructions: Indicate if patient was diagnosed with atrial fibrillation or flutter during this
admission.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: Fibrillation of > 30 seconds, which presents as supraventricular
complexes at an irregular rhythm and no obvious P waves on ECG; or Flutter presents as
identically recurring regular sawtooth flutter waves on ECG and evidence of continual electrical
activity.
Note(s): Code "No" If there is no documentation of atrial arrhythmias during hospitalization, it is
acceptable to code "No"
Source: Adapted from AHA Get with the Guidelines ACTION registry
Smoking Cessation Counseling
Coding Instructions: Indicate if there was documentation in the medical record that smoking
cessation advice or counseling was given during this admission.
Note(s): This element is referenced in The Joint Commission AMI Core Measures AMI-4.
Target Value: Any occurrence between arrival at this facility and discharge
Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Adapted from AHA Get with the Guidelines ACTION registry
Discharge Suggestions
Coding Instructions: Indicate if there was documentation of the following recommendations at
discharge
Target Value: as below
Selections:
a. Dual antiplatelet therapy (aspirin and a thienopyridine) (1) No (2) Yes If yes, specify the
duration
b. Regular blood lipid assessment (1) No (2) Yes
c. Dietary improvement (1) No (2) Yes
d. Weight reduction (1) No (2) Yes
e. Smoking cessation (1) No (2) Yes
f. Regular exercise (1) No (2) Yes
g. PCI (1) No (2) Yes
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h. CABG (1) No (2) Yes
i. None of the Above Is Recorded (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Discharge Diagnosis (Related to Coronary Heart Disease)
Coding Instructions: Indicate the discharge diagnosis mentioned in the chart
Note(s): Marks as many of the choices that apply.
Selections: Coronary Heart Disease, Acute Coronary Syndrome, Acute Myocardial Infarction,
Acute Extensive Anterior Myocardial Infarction, Acute Anterior Myocardial Infarction, Acute
Septal Myocardial Infarction, Acute Inferior Myocardial Infarction, Acute Lateral Myocardial
Infarction, Acute Posterior Myocardial Infarction, Acute Right Ventricular Myocardial Infarction,
Acute Non ST-Elevation Myocardial Infarction, Acute ST-Elevation Myocardial Infarction,
Subendocardial Myocardial Infarction, Acute Myocardial Infarction Suspected, Previous Q-Wave
Myocardial Infarction, Unstable Angina Pectoris, Stable Angina Pectoris, Prinzmetal's Angina,
Angina (Unrecorded Subtype), Repeated/Recurrent Myocardial Infarction, Repeated/Recurrent
Unstable Angina, Cardiac Rupture, Papillary Muscle Rupture, Ventricular Septal Perforation,
Cardiac Tamponade, Pericardial Effusion, Cardiogenic Shock, Cardiac Arrest, Atrial Fibrillation,
Ventricular Tachycardia/Ventricular Fibrillation, Acute Heart Failure, Chronic Heart Failure,
Heart Failure (Unspecified), Acute Pulmonary Edema, Gastrointestinal Bleeding, Genitourinary
Bleeding, Intracranial/Subdural Bleeding, Retroperitoneal Bleeding, Access Site Bleeding
(Including Hematoma at Access Site), Pericardial Bleeding , Bleeding (Unspecified),
Hemorrhagic Shock, Venous Thromboembolism, Pulmonary Embolism, Deep Vein Thrombosis,
Ischemic Stroke (Cerebral Infarction/Thrombosis/Cerebral Embolism), Hemorrhagic Stroke
(Cerebral Hemorrhage/Subarachnoid Hemorrhage), Stroke (Unspecified), Pneumonia, Infection,
COPD Exacerbation, Dyslipidemia, Hypertension, Diabetes Mellitus, Diabetic Nephropathy,
Acute Renal Failure, Chronic Renal Failure, Dialysis (Hemodialysis/Peritoneal Dialysis),
Contrast Reaction (Include Severe Allergic Reaction), Contrast-Induced Nephropathy (CIN),
Thrombocytopenia, Gastroesophageal Reflux, Esophagismus, --Cholelithiasis, Anemia,
Unrecorded.
Supporting Definition: If none of the above options is noted in the chart, mark “None of the
above Is Recorded”.
Source: Definition per CORE team
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Discharge Diagnosis (Unrelated to Coronary Heart Disease)
Coding Instructions: Indicate the discharge diagnosis mentioned in the chart
Note(s): Marks as many of the choices that apply.
Selections: Cardiac rupture, papillary muscle rupture, ventricular septal perforation, cardiac
tamponade, cardiogenic shock, cardiac arrest, atrial fibrillation/flutter, ventricular
tachycardia/fibrillation, heart failure, gastrointestinal bleeding, genitourinary bleeding,
intracranial/subdural bleeding, retroperitoneal bleeding, access site bleeding, pericardial
bleeding, bleeding (unspecified), hemorrhagic shock, venous thromboembolism, pulmonary
embolism, deep vein thrombosis, peripheral embolization, access site arteriovenous fistula,
ischemic stroke, hemorrhagic stroke, stroke (unspecified), pneumonia, COPD exacerbation,
acute renal failure, chronic renal failure, dialysis, infection, septicemia, contrast reaction,
dyslipidemia, hypertension, diabetes mellitus, diabetic nephropathy, trauma, hepatitis, cirrhosis,
anemia.
Supporting Definition: If none of the above options is noted in the chart, mark “None of the
above Is Recorded”.
Source: Definition per CORE team
International Classification of Diseases (ICD) Discharge Codes
Coding Instructions: For every diagnosis, record the associated ICD code
Target Value: This should be performed for every diagnosis
Selections: (1) ICD 9; specify value (2) ICD 10; specify value (3) Unrecorded
Supporting Definition: (none)
Source: Definition per CORE team
Date of Hospital Discharge
Coding Instructions: Indicate the date on which the patient was discharged from the hospital
Selections: (none)
Supporting Definitions: (none)
Source: Definition per CORE team
Transferred to Outside Facility
Coding Instructions: Indicate if the patient was transferred to an outside facility after initial
presentation to your hospital.
Target Value: N/A
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Selections: (1) No (2) Yes
Supporting Definitions: (none)
Source: Definition per CORE team
Discharge Status (or Disposition)
Coding Instructions: Indicate the documented nature of the patient’s discharge from the hospital.
Target Value: Any value at discharge
Selections: (1) Discharge without Transfer to Another Hospital
(2) Physician Recommends Transfer to Another Hospital
(3) Patient or Relatives Demand Transfer to Another Hospital
(4) Patient Left Against Medical Advice
(5) None of the Above Is Recorded
Supporting Definition: (none)
Source: Definition per China team
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CHINA PEACE-RETROSPECTIVE CATHPCI STUDY SITE INVESTIGATORS BY HOSPITAL Affiliated Hospital of Guiyang Medical College, Lirong Wu, Jiulin Chen; Affiliated Hospital of Hainan Medical College, Tianfa Li, Jun Wang; Affiliated Zhongshan Hospital of Dalian University, Qin Yu, Xiaofei Liu; Changda Hospital Of Anshan City, Xiang Jin, Ting Cai; Dalian Municipal Central Hospital, Yongchao Zhi, Lili Sun; Fourth Hospital of Baotou City, Hongbao Zhang, Yonghou Yin, Bin Tian; Fourth People's Hospital of Zigong City, Yong Yi, Chaoyong Wu; Fujian Provincial Hospital, Yansong Guo, Xinjing Chen; Fuling Center Hospital of Chongqing City, Liquan Xiang, Lin Ning; General Hospital of the Yangtze River Shipping, Xiuqi Li, Xing’an Wu; Guilin People's Hospital, Wei Zhang, Yanni Zhuang, Hua Lu; Haerbin 242 Hospital, Yin Zhou, Qiuling Hu; Henan Provincial People's Hospital, Chuanyu Gao, Jianghong Zhang, You Zhang; Heze Municipal Hospital, Wentang Niu, Xiaolei Ma, Yong Wang; HGKY Group Company General Hospital, Xiaowen Pan, Yanlong Yan; Hua Xin Hospital, First Hospital of Tsinghua University, Lifu Miao, Yanping Yin, Zhiying Zhang; Huizhou Municipal Central Hospital, Yuansheng Shen, Zhiming Li, Lizhen He; Hunan Province Mawangdui Hospital, Zhiyi Rong, Wei Luo; Ji'an Municipal Central People's Hospital, Xueqiao Wang; Jiangxi Provincial People's Hospital, Qing Huang, Xiaohe Wu; Jilin Integrated Traditional Chinese & Western Medicine Hospital, Jilin Province, Jiangping Shi; Jilin Province People's Hospital, Hui Dai, Yuming Du, Wei Guo; Jingzhou Central Hospital, Xin Li, Qin Xu; Jiuquan City People's Hospital, Yuanfeng Yuan, Zhirong Li; Jixi People's Hospital of The Jixi Municipal People's Hospital Medical Group, Jinbo Gao; Liaoyang Central Hospital, Rihui Liu, Peng Guo; Liaoyuan Central Hospital, Chaoyang Guo, Xiangjun Liu, Rujun Zhao, Zeyong Yu; Longyan First Hospital, Kaihong Chen, Yong Fang, Ying Liao; Nanjing First Hospital, Shaoliang Chen, Haibo Jia, Hongjuan Peng; Nantong Third People's Hospital, Song Chen, Dongya Zhang, Ying Wang; Nanyang Central Hospital, Yudong Li, Jianbu Gao, Shouzhong Yang; Peking University People's Hospital, Chenyang Shen, Yunfeng Liu; Peking University Shenzhen Hospital, Chun Wu, Huan Qu, Saiyong Chen; Qinghai Red Cross Hos, Jianqing Zhang, Chunmei Wei, Yanmei Shen; Quzhou People's Hospital, Xiaoming Tu, Zhenyan Gao; Shangluo Central Hospital, Yingmin Guan, Wenfeng Wang, Ting Xiao; Shangqiu Changzheng People's Hospital, Qian Wang; Shenyang Weikang Hospital, Xujie Fu, Shu Zhang; Shougang Shuicheng Iron & Steel (Group) Co.,Ltd. General Hospital, Min Zhang, Kai Fu, Xiaojing Duan; Shuangshan Hospital Of Anshan, Rui Xiao, Ruixia Wu, Bin Li; The Affiliated Hospital of Beihua University, Feng Sun, Qi Zhang; The Fifth People's Hospital of Dalian, Jing Zhang, Yang Zhong; The First Affiliated Hospital of Hebei Northern Institute, Fangjiang Fang, Xiaoyuan Wang; The First Affiliated Hospital of Henan University of Science & Technology, Pingshuan Dong, Laijing Du, Wei Liu; The First Affiliated Hospital Of Jia Mu Si University, Zhaofa He, Meihua Jin; The First Hospital of Fuzhou City, Ting Jiang, Zhuoyan Chen; The First Hospital of Xi’an, Manli Cheng, Yuqiang Ji; The First People's Hospital of Guangyuan, Yizhi Pan, Jian Liu; The First People's Hospital of Guangyuan, Tianxun Wang, Ping Yang; The Fourth people's hospital Of Shang qiu shi, Guiyu Huang, Jianjun Pan, Zhiyong Zhang; The General Hospital of Yongzhou, Mingli Lv; The Second Affiliated Hospital of Harbin Medical University, Bo Yu, Yousheng Xu, Zhengqiu Wang; The Second Affiliated Hospital of Kunming Medical University, Jun Shu, Ge Zhang, Kai Li; The Second People's Hospital of Liaoyuan City, Aimin Zhang, Yongfen Kang; Tianjin Medical University General Hospital, Zheng Wan, Bo Bian; Tibet Autonomous Region People's Hospital, Xuejun Hu, Dawa Ciren; Tongchuan Mining Bureau Central Hospital, Guojiong Jia, Lijie Pan; Tongliao City Horqin District First People's Hospital, Junping Fang, Xinli Yu; Ulanqab Central Hospital, Dacheng Wang, Dajun Liu, Xinhong Cao; Wuhai People's Hospital, Zhaohai Zhou, Lei Shi; Wuhu Second People's Hospital, Wuwang Fang, Manxin Chen; Yuanzhou District People's Hospital of Guyuan City, Xiaoping Gao, Meiying Cai, Lining You; Yuncheng Central Hospital, Xuexin Li, Shuqin Li, Yingjia Li.
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CHINA PEACE STUDY CONSULTANTS Study Consultants: Paul S. Chan, MD, MSc, Jersey Chen, MD, MPH, David J. Cohen, MD, MSc, Nihar R. Desai, MD, MPH, Kumar Dharmarajan MD, MBA, Mikhail N. Kosiborod, MD, Jing Li, MD, PhD, Xi Li, MD, PhD, Zhenqiu Lin, PhD, Frederick A. Masoudi, MD, MSPH, Jennifer Mattera, DrPH, MPH, Brahmajee K. Nallamothu, MD, MPH, Khurram Nasir, MD, MPH, Sharon-Lise T. Normand, PhD, Joseph S. Ross, MD MHS, John A. Spertus, MD, MPH, Henry H. Ting, MD, Yun Wang, PhD, Xiao Xu, PhD St. Luke’s Mid America Heart Institute/University of Missouri Kansas City (PSC, DJC, MNK, JAS), Kansas City, Missouri, United States; Kaiser Permanente (JC), Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States; Center for Outcomes Research and Evaluation (NRD, KD, ZL, JM, JSR, YW, XX), Yale-New Haven Hospital, New Haven, Connecticut, United States; Division of Cardiology (KD), Department of Internal Medicine, Columbia University Medical Center, New York, New York, United States; State Key Laboratory of Cardiovascular Disease (JL, XL), China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Division of Cardiology (FAM), University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States; Veterans Affairs Health Services Research and Development Center of Excellence (BKN), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States; Department of Internal Medicine (BKN) and Center for Healthcare Outcomes and Policy (BKN), University of Michigan, Ann Arbor, Michigan, United States; Research Director, Center for Prevention and Wellness (KN), Baptist Health South Florida, Miami, Florida, United States; Section of General Internal Medicine and the Robert Wood Johnson Clinical Scholars Program (JSR), Department of Internal Medicine, Yale University School of Medicine, Connecticut, United States; Division of Cardiovascular Diseases (HHT) and Knowledge and Evaluation Research Unit (HHT), Mayo Clinic College of Medicine, Rochester, Minnesota. United States; Department of Obstetrics, Gynecology, and Reproductive Sciences (XX), Yale School of Medicine, New Haven, Connecticut, United States
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STROBE Statement Checklist of items that should be included in reports of cohort studies
Item No Recommendation
Title and abstract 1 (a) Indicate the study’s design with a commonly used term in the
title or the abstract – DONE (retrospective)
(b) Provide in the abstract an informative and balanced summary
of what was done and what was found – DONE (what was done)
Introduction
Background/rationale 2 Explain the scientific background and rationale for the
investigation being reported - DONE
Objectives 3 State specific objectives, including any prespecified hypotheses -
DONE
Methods
Study design 4 Present key elements of study design early in the paper – DONE
Setting 5 Describe the setting, locations, and relevant dates, including
periods of recruitment, exposure, follow-up, and data collection –
DONE
Participants 6 (a) Give the eligibility criteria, and the sources and methods of
selection of participants. Describe methods of follow-up – DONE
(b) For matched studies, give matching criteria and number of
exposed and unexposed – N/A
Variables 7 Clearly define all outcomes, exposures, predictors, potential
confounders, and effect modifiers. Give diagnostic criteria, if
applicable – DONE (key variables, approach to statistical
analysis, and key outcomes presented in manuscript)
Data sources/
measurement
8* For each variable of interest, give sources of data and details of
methods of assessment (measurement). Describe comparability of
assessment methods if there is more than one group – DONE (in
manuscript and supplement)
Bias 9 Describe any efforts to address potential sources of bias – DONE
(demonstrated how nationally representative data set was
acquired)
Study size 10 Explain how the study size was arrived at – DONE
Quantitative variables 11 Explain how quantitative variables were handled in the analyses. If
applicable, describe which groupings were chosen and why – N/A
(no statistical analyses performed)
Statistical methods 12 (a) Describe all statistical methods, including those used to control
for confounding – DONE (approach to statistical analysis
presented)
(b) Describe any methods used to examine subgroups and
interactions – N/A (no statistical analyses performed)
(c) Explain how missing data were addressed – N/A (no
statistical analyses performed)
(d) If applicable, explain how loss to follow-up was addressed –
N/A (no post-discharge follow-up)
(e) Describe any sensitivity analyses – N/A
Results
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Participants 13* (a) Report numbers of individuals at each stage of study—eg
numbers potentially eligible, examined for eligibility, confirmed
eligible, included in the study, completing follow-up, and analysed
– DONE (total numbers presented)
(b) Give reasons for non-participation at each stage – DONE
(reasons for missing data provided)
(c) Consider use of a flow diagram – N/A for protocol paper; will
include with each study based on database
Descriptive data 14* (a) Give characteristics of study participants (eg demographic,
clinical, social) and information on exposures and potential
confounders – Not possible until data has been analyzed
(b) Indicate number of participants with missing data for each
variable of interest – Not possible until data has been analyzed
(c) Summarise follow-up time (eg, average and total amount) –
N/A (all observations restricted to in-hospital follow-up)
Outcome data 15* Report numbers of outcome events or summary measures over
time – Not possible until data has been analyzed
Main results 16 (a) Give unadjusted estimates and, if applicable, confounder-
adjusted estimates and their precision (eg, 95% confidence
interval). Make clear which confounders were adjusted for and
why they were included – DONE (expected precision
calculations provided in appendix)
(b) Report category boundaries when continuous variables were
categorized – Not possible until data has been analyzed
(c) If relevant, consider translating estimates of relative risk into
absolute risk for a meaningful time period – Not possible until
data has been analyzed
Other analyses 17 Report other analyses done—eg analyses of subgroups and
interactions, and sensitivity analyses – Not possible until data
has been analyzed
Discussion
Key results 18 Summarise key results with reference to study objectives – Not
possible until data has been analyzed
Limitations 19 Discuss limitations of the study, taking into account sources of
potential bias or imprecision. Discuss both direction and
magnitude of any potential bias – DONE
Interpretation 20 Give a cautious overall interpretation of results considering
objectives, limitations, multiplicity of analyses, results from similar
studies, and other relevant evidence – Not possible until data
has been analyzed
Generalisability 21 Discuss the generalisability (external validity) of the study results –
DONE (reported generalizability of data set in general)
Other information
Funding 22 Give the source of funding and the role of the funders for the
present study and, if applicable, for the original study on which the
present article is based - DONE
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