eMeasure Title Primary PCI Received Within 90 Minutes of Hospital Arrival
eMeasure Identifier
(Measure Authoring Tool)
53 eMeasure Version number 2
NQF Number 0163 GUID 84b9d0b5-0caf-4e41-b345-3492a23c2e9f
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Measure Developer Oklahoma Foundation for Medical Quality
Endorsed By National Quality Forum
Description
Acute myocardial infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival to PCI of 90 minutes or less.
Copyright
Measure specifications are in the Public Domain.

LOINC (R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The early use of primary angioplasty in patients with ST-segment myocardial infarction (STEMI) results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is (Brodie, 1998 and DeLuca, 2004). National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarction (Antman, 2004; Antman, 2008; and Kushner, 2009).
Clinical Recommendation Statement
National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarction
Improvement Notation
Higher score indicates better quality
Reference
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
Reference
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;51:210–47.
Reference
Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, et al. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998;32:1312-9.
Reference
DeLuca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109(10):1223-1225.
Reference
Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 –99.
Reference
Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54:2205– 41.
Definition
None
Guidance
The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec.

Denominator element guidance:
The denominator and numerator criteria indicate scenarios in which the patient is admitted to the hospital directly or the patient is admitted from the Emergency Department (ED). The calculation is to indicate the timing from arrival at the facility to the occurrence of an event.

For the denominator data element "Diagnostic Study, Result: Hospital Measures-ECG Impression," EHR implementations will need to develop mechanisms to capture ECG findings to support denominator criteria for this measure. The measure specification indicates allowable findings. The source of the ECG results should be a physician/APN/PA (rather than the ECG machine's computerized results).

Numerator element guidance:
This measure expects a PCI procedure within 90 minutes of hospital arrival.  Those patients receiving PCI procedures greater than 90 minutes after arrival may be excluded from the denominator only if there is a documented reason for a delay or documented occurrence of intubation, cardiopulmonary arrest or mechanical circulatory assist device placement within the first 90 minutes after arrival. Patients receiving PCI procedures greater than 90 minutes after arrival and with no reason provided are not compliant with the numerator criteria and will remain in the denominator.

Exclusion element guidance: 
The intent for the exclusion for patients who are clinical trial participants was to be limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI), heart attack, or acute coronary syndrome (ACS), the same conditions as covered by the measure. However, the value set specifying clinical trial participation is not limited to a specific type of trial; therefore, this piece of logic will not be included in certification testing or reviewed on audit at this time.

Transfers from another hospital are excluded since care may have been delivered in the other setting. Transfers from those hospitals are considered exclusions regardless of whether the receiving hospital has the same or different hospital unique identifier as the transferring hospital. PCI procedures analyzed in this measure must be primary procedures. Primary includes emergent or urgent PCI procedures and not those described by the physician/APN/PA anywhere in the record as elective, not emergent, not immediate, not primary, not urgent, or secondary.  

From a clinical standpoint, Primary PCI is loosely defined as percutaneous coronary intervention performed in the acute setting in patients with ST segment elevation MI which is intended to restore perfusion in the infarct-related artery. In randomized trials and observational studies, this therapy is associated with significant reductions in the risks of adverse events, including death, in selected patients with STEMI.
Transmission Format
None
Initial Patient Population
All hospital discharges for acute myocardial infarction (AMI) with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission with ST-elevation or left bundle branch block (LBBB) on electrocardiogram (ECG) who received primary percutaneous coronary intervention (PCI)
Denominator
AMI patients age 18 and older with ST-elevation or LBBB on ECG who received primary PCI with an ICD-9-CM Principal Diagnosis Code for AMI AND PCI (ICD-9-CM Principal and Other Procedure Codes for PCI) AND ST-segment elevation or LBBB on the ECG performed closest to hospital arrival AND PCI performed within 24 hours after hospital arrival
Denominator Exclusions
Patients enrolled in clinical trials.
Patients received as a transfer from an inpatient or outpatient department of another hospital.
Patients received as a transfer from the emergency/observation department of another hospital.
Patients received as a transfer from an ambulatory surgery center.
Patients administered fibrinolytic agent prior to PCI

PCI described as non-primary by a physician/advanced practice nurse/physician assistant (physician/APN/PA). Patients who did not receive PCI within 90 minutes and had a documented reason for delay in PCI.
Numerator
AMI patients whose time from hospital arrival to primary PCI is 90 minutes or less
Numerator Exclusions
Not applicable
Denominator Exceptions
None
Measure Population
Not applicable
Measure Observations
Not applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
Acute Myocardial Infarction (AMI)