Table 3

Clinical Presentation Data Elements and Definitions

Element NameElement Definition
Symptom onset date/timeIndicate the date and time the patient first noted ischemic symptoms lasting ≥10 min. If the patient had intermittent ischemic symptoms, record the date and time of the most recent ischemic symptoms before hospital presentation. Symptoms may include jaw pain, arm pain, shortness of breath, nausea, vomiting, fatigue/malaise, or other equivalent discomfort suggestive of an MI. In the event of stuttering symptoms, ACS symptom onset is the time at which symptoms became constant in quality or intensity.
Heart failure on first medical contact
  • Indicate if there is physician documentation or a report of heart failure on the first medical contact.

  • 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 distention, pulmonary edema on physical exam, or pulmonary edema on chest x-ray. A low ejection fraction without clinical evidence of heart failure does not qualify as heart failure.

  • Note: Killip class 2 is defined as rales over ≤50% of the lung fields or the presence of an S3. Killip class 3 is defined as rales over >50% of the lung fields. Either class would qualify as a “yes.”

Killip class
  • Indicate the patient's Killip class at the time of hospital admission:

  • • Class 1: absence of rales over the lung fields and absence of S3

  • • Class 2: rales over ≤50% of the lung fields or the presence of an S3

  • • Class 3: rales over >50% of the lung fields

  • • Class 4: shock

Heart rateIndicate the first measurement or earliest record of heart rate (in beats per minute) for this episode of care. Measurement from the transferring facility is acceptable.
Systolic blood pressure on first medical contactIndicate the first measurement or earliest record of systolic blood pressure (in millimeters of mercury) for this episode of care. Measurement from the transferring facility is acceptable.
Angina type
  • Indicate the category of the patient's type of angina if present. Choose 1 of the following:

  • • I. Atypical chest pain: pain, pressure, or discomfort in the chest, neck, or arms not clearly exertional or not otherwise consistent with pain or discomfort of myocardial ischemic origin.

  • • II. Stable angina: angina without a change in frequency or pattern for the 6 wk before this procedure. Angina is controlled by rest and/or sublingual/oral/transcutaneous medications.

  • • III. ACS (choose 1 of the following):

  •  - A. UA: The patient was hospitalized for UA documented in the medical record with serial ECGs and biochemical profiles. One of the following criteria is necessary:

  •   1. Angina that occurred at rest and was prolonged, usually lasting ≥10 min

  •   2. New-onset angina of at least CCS classification III severity

  •   3. Recent acceleration of angina reflected by an increase in severity of at least 1 CCS class to at least CCS class III. The patient must also not have any biochemical evidence of myocardial necrosis.

  •  - B. MI: For a complete definition, please see “MI” in the “Outcomes” section.

Number of episodes of angina in the past 24 hIndicate the number of distinct episodes of anginal pain that occurred in the past 24 h before hospital admission.
Secondary cause of angina (yes/no)Note whether angina was precipitated by a secondary factor such as fever, anemia, hypoxemia, tachycardia, thyrotoxicosis, or severe valvular disease as defined by Braunwald.
Cardiac arrest at first medical contact
  • Indicate if the patient has had an episode of cardiac arrest evaluated by EMS or ED personnel and either 1) received external defibrillation attempts (by lay responders or emergency personnel) or chest compressions by organized EMS or ED personnel or 2) were pulseless but did not receive defibrillation attempts or CPR by EMS personnel.

  • Choose 1 of the following:

  • • Yes

  • • No

  • Note: [Sudden] cardiac arrest is the sudden cessation of cardiac activity. 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 death should not be used to describe events that are not fatal.

HeightIndicate the patient's first recorded height in centimeters on admission/encounter to your facility.
WeightIndicate the patient's weight in kilograms closest to the date of admission/encounter.
Waist circumferenceIndicate waist circumference based on the average of 2 measurements made while the patient is standing. Take 1 measurement after inspiration and another after expiration. Measurements should be taken at the midpoint between the lowest rib and the iliac crest. Indicate in centimeters.

ACS indicates acute coronary syndromes; CCS, Canadian Cardiovascular Society; CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; ED, emergency department; EMS, emergency medical services; MI, myocardial infarction; and UA, unstable angina.