eMeasure Title

Primary PCI Received Within 90 Minutes of Hospital Arrival

eMeasure Identifier (Measure Authoring Tool) 53 eMeasure Version number 5.4.000
NQF Number 0163 GUID 84b9d0b5-0caf-4e41-b345-3492a23c2e9f
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer Oklahoma Foundation for Medical Quality
Endorsed By National Quality Forum
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.
Copyright
Measure specifications are in the Public Domain.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2015 International Health Terminology Standards Development Organization. All rights reserved.

LOINC (R) is a registered trademark of the Regenstrief Institute.
Disclaimer
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.
Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Encounter Inpatient
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 (O'Gara, 2013; and Levine 2011).
Clinical Recommendation Statement
National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarction.
Improvement Notation
Improvement noted as an increase in rate
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
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44-122.
Reference
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485-510.
Definition
None
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 the majority of cases.
Transmission Format
TBD
Initial Population
Patients age 18 and older at the time of hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) with hospital stays <= 120 days during the measurement year
Denominator
Initial population with an ECG (result: Acute or Evolving MI) 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
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 has 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"
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
Acute Myocardial Infarction (AMI)