Primary PCI Received Within 90 Minutes of Hospital Arrival

Last updated: May 3, 2018

CMS Measure ID: CMS53v6
Version: 6
NQF Number: None
Measure Description:

Acute myocardial infarction (AMI) patients with ST-segment elevation 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

Initial Patient Population:

Patients age 18 and older at the time of hospital admission with a principal diagnosis of an Acute or Evolving Myocardial Infarction (ST-segment elevation MI) with hospital stays <= 120 days during the measurement period

Denominator Statement:

Initial population with an ECG performed and a primary PCI procedure closest to the inpatient admission that does not start after fibrinolytic therapy

Denominator Exclusions:

Patients who transferred from another hospital's inpatient, outpatient, or emergency department and ambulatory surgery center facilities are excluded

Numerator Statement:

AMI patients whose time from hospital arrival to primary PCI is 90 minutes or less

Numerator Exclusions:

Not applicable

Denominator Exceptions:

Patients who did not receive PCI within 90 minutes and have a documented reason. Documented reasons include:

Diagnosis: Cardiopulmonary arrest

Procedure, Performed: Endotracheal Intubation

Procedure, Performed: Aortic balloon pump insertion

Procedure, Performed: Ventricular Assist Device placement

Measure Steward: Centers for Medicare and Medicaid Services (CMS)
Short Name: AMI8a
Next Version:
Previous Version:
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

To identify the ECG closest to hospital arrival, the denominator will identify the most recent ECG performed that starts less than 1 hour prior to the emergency department (ED) or inpatient encounter OR the first ECG performed starts after the ED or inpatient encounter started.

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. There is currently no way to explicitly express this in QDM, however, using 'FIRST' will likely capture the intent in the majority of cases.

Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Replaced NQF Number '0163' with 'Not Applicable​' as the measure is no longer endorsed.

    Measure Section: NQF Number

    Source of Change: Measure Lead

  • Replaced 'National Quality Forum' with 'None' as the measure is no longer endorsed.

    Measure Section: Endorsed By

    Source of Change: Measure Lead

  • Changed measurement year to measurement period to be consistent with logic changes and harmonize across measures.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the Initial Population narrative statement by changing the principal diagnosis from Acute Myocardial Infarction to Acute or Evolving Myocardial Infarction, adding clarification that the Acute or Evolving is an ST-segment elevation MI.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the Denominator narrative statement by adding ECG performed and removing the result: Acute or Evolving to be consistent with logic changes.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Changed 'has' to 'have' to improve the sentence structure. Sentence now reads 'Patients who did not receive PCI within 90 minutes and have a documented reason.'.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

Logic

  • Changed the principal diagnosis from Acute Myocardial Infarction (AMI) to Acute or Evolving Myocardial Infarction to simplify the logic while meeting the intent of the measure to capture ST-segment elevation MIs.

    Measure Section: Initial Population

    Source of Change: JIRA (CQM-2220)

  • Removed two lines of logic: 'Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: Acute or Evolving MI)' and AND NOT: 'Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: STEMI Exclusions)' to simplify the logic. The ECG result of Acute or Evolving is no longer needed since the Initial Population now captures the Acute or Evolving MI cases. The STEMI exclusions check would be redundant since only STEMI codes would be captured in the Initial Population.

    Measure Section: Denominator

    Source of Change: JIRA (CQM-2220)

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Endotracheal Intubation (2.16.840.1.113762.1.4.1045.69): Deleted four ICD9CM codes (96.04, 96.70, 96.71, 96.72).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Ventricular Assist Device placement (2.16.840.1.113883.3.666.5.3015): Deleted six ICD9CM codes (37.52, 37.60, 37.62, 37.65, 37.66, 37.68).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Acute or Evolving MI (2.16.840.1.113883.3.666.5.3022): Deleted 16 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Fibrinolytic Therapy (2.16.840.1.113883.3.666.5.736): Added 2 RXNORM codes (1804799, 1804804) and deleted 1 RXNORM code (308056).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Cardiopulmonary arrest (2.16.840.1.113883.3.666.5.748): Deleted 3 ICD9CM codes (427.41, 427.5, 799.1).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PCI (2.16.840.1.113762.1.4.1045.67): Deleted 1 ICD9CM code (00.66). Added 2 SNOMEDCT codes (698740005, 707828002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Removed the Acute Myocardial Infarction (AMI) Grouping Value Set (2.16.840.1.113883.3.666.5.3011) and the STEMI Exclusions Grouping Value Set (2.16.840.1.113762.1.4.1045.36) to align with logic changes.

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-2220)

  • Removed ICD9CM extensional value sets from their associated grouping value sets as there are no lookback periods in this measure.

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-2220)

  • Value set Ventricular Assist Device placement (2.16.840.1.113883.3.666.5.3015): Added 3 ICD10PCS codes (02HA0RJ, 02HA3RJ, 02HA4RJ).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources