Table 4

Diagnostic Procedure Data Elements and Definitions

Element NameElement Definition
Electrocardiography
Rhythm
  • The categories of rhythm are

  • • Sinus rhythm

  • • Atrial fibrillation (or flutter)

  • • Paced

  • • Other rhythm (e.g., VT, supraventricular tachycardia)

Site where first ECG obtained
  • Indicate where the first ECG was obtained.

  • Choose 1 of the following:

  • • Prehospital (i.e., in ambulance): Check if the first ECG was obtained before arrival at your hospital, either during ground transport by EMS, air ambulance, or other method of critical care transport.

  • • On arrival to the first hospital where the patient presented: Check if the first ECG performed after the most recent ischemic episode before hospital presentation was obtained on arrival at the first hospital where the patient presented.

  • • Private physician office or outpatient clinic

  • • Hospital inpatient unit

First ECG date/timeIndicate the date and time of the first ECG.
STEMI or STEMI equivalentIndicate if there was either new or presumed new ST-segment elevation, new LBBB, or isolated inferobasal MI before any procedures and not more than 24 h after the initial presentation.
ECG evidence for STEMI or STEMI equivalent
  • Indicate if there was either new or presumed new ST-segment elevation, new LBBB, or isolated inferobasal (posterior) MI noted on the ECG before any procedures and not more than 24 h after the initial presentation. Choose 1 of the following:

  • • New ST-segment elevation at the J point in 2 contiguous leads with the cutpoints ≥0.1 mV in all leads other than leads V2 through V3, where the following cutpoints apply: ≥0.2 mV in men age ≥40 y, ≥0.25 mV in men age <40 y, or ≥0.15 mV in women

  • • New isolated ST-segment depression ≥0.1 mV in at least 2 contiguous leads of V1 through V3 with upright T waves

  • • New ST-segment elevation ≥0.05 mV in leads V7 through V9 or ≥0.1 mV in men age <40 y (inferobasal [posterior] infarction)

  • • New ST-segment elevation ≥0.05 mV (≥0.1 mV in men age <30 y) in leads V3R, V4R (right ventricular infarction)

  • • New ST-segment elevation ≥0.1 mV in lead aVR with concomitant ST-segment depression ≥0.05 mV in at least 2 contiguous leads

STEMI or STEMI equivalent noted
  • Indicate if a STEMI or STEMI equivalent was noted on either the first or a subsequent ECG. The subsequent ECG must be performed within 24 h of initial presentation, either to your facility or the transferring facility if a transfer patient.

  • Choose 1 of the following:

  • • First ECG

  • • Subsequent ECG

STEMI or STEMI equivalent date/timeIndicate the date and time of the earliest subsequent ECG with ST-segment elevation, LBBB, or isolated inferobasal MI.
Other ischemic ECG findings
  • Indicate if other findings from the ECG were demonstrated within 24 h of the first medical contact.

  • Choose all that apply:

  • • New or presumed new ST-segment depression: Indicate if there was new or presumed new horizontal or downsloping ST depression ≥0.05 mV in 2 contiguous leads and/or T inversion ≥0.1 mV in 2 contiguous leads with prominent R wave or R/S ratio >1. T-wave negativity may be normal in leads with predominant negative QRS complexes (see discussion) but are usually abnormal when the QRS complex is upright.

  • • New or presumed new T-wave inversion: Indicate if there was a new or presumed new T-wave inversion of at least 0.1 mV in 2 contiguous leads. The T wave usually has a polarity of the T-wave vector similar to the QRS vector. Thus, in normal subjects, negative T waves may be observed when the QRS is negative (e.g., lead aVL with vertical axis). Juvenile T-wave patterns, marked pectus excavatum, and other conditions may also be associated with T-wave inversion that is not ischemic in origin.

  • • Transient ST-segment elevation lasting <20 min: Indicate if there was new or presumed new ST-segment elevation at the J point in 2 contiguous leads with the cutpoints ≥0.1 mV in all leads other than leads V2 through V3, where the following cutpoints apply: ≥0.2 mV in men age ≥40 y, ≥0.25 mV in men age <40 y, or ≥0.15 mV in women.

  • • Indicate if a new persistent LBBB was present.

  • • None of the above: Indicate if the first ECG did not reveal ST-segment depression, transient ST-segment elevation, or T-wave inversion.

Location of ECG changes
  • The location of each type of electrocardiographic change listed below can be divided into 4 categories:

  • • Inferior leads: II, III, aVF

  • • Anterior leads: V1 through V6

  • • Lateral leads: I, aVL,

  • • True posterior (inferobasal): (relevant only for tall wide R waves >40 ms in leads V1 and V2

  • Consideration can be given to recording posterior ST changes, the maximal amount of ST (if applicable), and/or the number of leads with ST.

BBB and typeThe presence of left or right BBB should be noted, as well as whether it is new, old, or of uncertain timing.
Follow-up ECG: new Q wavesIf a follow-up ECG is performed (at least 6 h after the initial ECG), the presence or absence of new Q waves that are ≥0.03 s in width, in at least 2 contiguous leads, and ≥1 mm (0.1 mV) in depth not seen on the initial ECG should be noted, as well as the location described above.
Laboratory Tests
LDL valueIndicate the value of the LDL cholesterol. If the value is reported using a “>” symbol (e.g., >300), record the number only (e.g., 300). Lipids obtained within the first 24 h of this admission should take precedence. If >24 h after admission, then enter prior values.
HDL valueIndicate the HDL-cholesterol value. If the value is reported using a “>” symbol (e.g., >300), record the number only (e.g., 300). Lipids obtained within the first 24 h of this admission should take precedence. If >24 h after admission, then enter prior values.
Triglycerides valueIndicate the value of triglycerides. If the value is reported using a “>” (e.g, >300), record the number only (e.g., 300). Lipids obtained within the first 24 h of this admission should take precedence. If >24 h of admission, then enter prior values.
Date of lipidsIndicate the date the sample was collected (not the date and time results reported) OR check either “Performed before hospitalization” or “Unknown.” Lipids obtained within the first 24 h of this admission should take precedence. If >24 h after admission, then enter prior values.
When lipids were measured: otherIndicate the date and time the sample was collected (not the date and time results reported) OR check either “Performed before hospitalization” or “Unknown.” Lipids obtained within the first 24 h of this admission should take precedence. If >24 h after admission, then enter prior values.
BNP/NT-proBNP valueIndicate the results from first BNP or first NT pro-BNP performed during this admission. If done, enter the numerical value and specify which assay type was done.
hs-CRPIndicate the value of the first serum hs-CRP level and units.
GlucoseIndicate the first glucose value taken. Indicate if fasting or not.
CreatinineIndicate the creatinine value taken at the time of admission and at the time of discharge.
HemoglobinIndicate the value and units for the first hemoglobin collected during this admission. Date and time of collection should also be indicated.
Hemoglobin A1c valueIndicate the percentage value for the first hemoglobin A1c collected during this admission. Date and time of collection should also be indicated.
INRIndicate the numerical value of INR on admission. Date and time of collection should also be indicated.
Initial CK valueIndicate the results of the first CK sample obtained within the first 24 h of care, either from a transferring hospital or your hospital. If the patient was transferred into your hospital, data available from the transferring facility should take precedence.
Peak CK valueIndicate the results of the peak CK sample obtained during this admission.
CK ULNIndicate the total CK ULN as defined by individual hospital laboratory standards. The units of CK and type of units (e.g., IU, ng/dL, kCat/L) should be noted.
Initial CK-MB valueIndicate the initial CK-MB value. The initial sample value refers to the first sample obtained within the first 24 h of care, either from a transferring hospital or your hospital. If the patient was transferred, data available from the transferring facility should take precedence.
CK-MB ULN
  • Indicate the initial CK-MB sample ULN for the test. If a range is given, record the highest number in the range.

  • Examples:

  • 1. Reference range given as 0-5: Record ULN as 5

  • 2. ULN given as <5: Record ULN as 5

  • The initial sample value refers to the first sample obtained within the first 24 h of care, either from a transferring hospital or your hospital. If the patient was transferred, data available from the transferring facility should take precedence.

Peak CK-MB value
  • Indicate the results of the highest sample obtained during this admission.

  • Note: Enter the value. If the value is reported using a “<” symbol (e.g., “<0.02”), record the number only (e.g., “0.02”).

Initial troponin value
  • Indicate the results of the first sample obtained within the first 24 h of care, either from a transferring hospital or your hospital. If the patient was transferred, data available from the transferring facility should take precedence.

  • Note: Enter the value. If the value is reported using a “<” symbol (e.g., “<0.02”), record the number only (e.g., “0.02”).

Troponin type
  • Indicate which type:

  • • Type T

  •  - Indicate if high sensitivity

  • • Type I

  •  - Indicate if high sensitivity

Peak troponin value
  • Indicate the results of the highest sample obtained during this admission.

  • Note: Enter the value. If the value is reported using a “<” symbol (e.g., “<0.02”), record the number only (e.g., “0.02”).

BBB indicates bundle branch block; BNP, brain natriuretic peptide; CK, creatinine kinase; CK-MB, creatinine kinase MB isoenzyme; ECG, electrocardiogram; EMS, emergency medical services; HDL, high-density lipoprotein; hs-CRP, high-sensitivity C-reactive protein; INR, international normalized ratio; LBBB, left bundle-branch block; LDL, low-density lipoprotein; MI, myocardial infarction; NT-proBNP, N-terminal prohormone of brain natriuretic peptide; STEMI, ST-segment elevation myocardial infarction; VT, ventricular tachycardia; and ULN, upper limit of normal.