Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

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Measure Information	2023 Reporting Period
Title	Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)
CMS eCQM ID	CMS996v3
NQF Number	3613e
Description	Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival
Initial Population	All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period
Denominator	Equals Initial Population
Denominator Exclusions	Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Within 90 days before start of ED encounter: • Ischemic stroke • Significant facial and/or closed head trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy
Numerator	Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival.
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Steward	Centers for Medicare & Medicaid Services (CMS)
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Improvement noted as an increase in the rate
Guidance	This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
Telehealth Eligible	No
Next Version	No Version Available
Previous Version	No Version Available

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Measure Information	2023 Reporting Period
CMS eCQM ID	CMS996v3
NQF Number	3613e
Description	Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival
Initial Population	All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period
Denominator	Equals Initial Population
Denominator Exclusions	Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Within 90 days before start of ED encounter: • Ischemic stroke • Significant facial and/or closed head trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy
Numerator	Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival.
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Steward	Centers for Medicare & Medicaid Services (CMS)
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Improvement noted as an increase in the rate
Guidance	This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
Telehealth Eligible	No

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