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Release Notes:
Measure Information Form
Version 2010A1

Measure Information Form

Measure Set: Acute Myocardial Infarction(AMI)

Set Measure ID: AMI-8

Performance Measure Name: Median Time to Primary PCI

Description: Median time from arrival to primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time

Rationale: The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or LBBB 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 (Antman, 2004). Despite these recommendations, few eligible older patients hospitalized with AMI receive primary angioplasty within a timely manner (Jencks, 2000).

Type of Measure: Process

Improvement Noted As: Decrease in the median value

Continuous Variable Statement: Time (in minutes) from hospital arrival to primary PCI in patients with ST-segment elevation or LBBB on the ECG performed closest to hospital arrival
Included Populations: Discharges with:
  • An ICD-9-CM Principal Diagnosis Code for AMI as defined in Appendix A, Table 1.1
  • PCI (ICD-9-CM Principal and Other Procedure Codes for PCI as defined in Appendix A, Table 1.2)
  • ST-segment elevation or LBBB on the ECG performed closest to hospital arrival
  • PCI performed within 24 hours after hospital arrival

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a Length of Stay >120 days
  • Patients with Comfort Measures Only documented on day of or day after arrival
  • Patients enrolled in clinical trials
  • Patients received as a transfer from an acute care facility where they were an inpatient or outpatient
  • Patients received as a transfer from one distinct unit of the hospital to another distinct unit of the same hospital
  • Patients received as a transfer from the emergency department of another hospital
  • Patients administered fibrinolytic agent prior to PCI
  • PCI described as non-primary by a physician/advanced practice nurse/physician assistant (physician/APN/PA)
  • Patients who did not receive PCI within 90 minutes and had a reason for delay documented by a physician/APN/PA (e.g., social, religious, initial concern or refusal, cardiopulmonary arrest)

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: The median time to primary PCI should be analyzed in conjunction with the measure rate for primary PCI received within 90 minutes of hospital arrival (AMI-8a). These measures, used together, will assist in understanding the median time to primary PCI, and will identify the number of AMI patients that are receiving primary PCI within 90 minutes of hospital arrival and potential opportunities for improvement to decrease the median time to primary PCI.

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate measure of central tendency .

Selected References:

  • Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
  • Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, Weintraub RA, Kelly TA. 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.
  • 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.
  • Jencks SJ, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, Nilasena DS, Ordin DL, Arday DR. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA. 2000;284:1670-1676.
  • Krumholz HM, Anderson JL, Brooks NH, Fesmir FM, Lambrew CT, Landrum MB, Weaver WD, Whyte J. ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on Performance Measures (ST-Elevation and Non–ST-Elevation Myocardial Infarction Performance Measures Writing Committee). J Am Coll Cardiol 2006;47:236–65. Available at http://www.acc.org and http://www.americanheart.org.

Measure Algorithm:

Attach file

Related Topics

Measure Information Form AMI-8
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)