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Protocol - Myocardial Infarction

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Description:

This measure assesses if an individual has had a myocardial infarction (MI) through collection of personal history of disease, treatment and procedure histories, and medical record abstraction.

Specific Instructions:

If the respondent answers "yes" to question 1 or question 2, the interviewer should complete the rest of the protocol. If the respondent answers "no" or "don't know," then the protocol is deemed complete.

Protocol:

1. Has a doctor ever told you that you had a myocardial infarction or heart attack?

[] 1 Yes

[] 0 No

[] 9 Don't Know

2. Have you had an outpatient or day surgery procedure to unblock blocked or narrowed blood vessels of the heart (called a PTCA, coronary angioplasty, stent, or atherectomy)?

[] 1 Yes

[] 0 No

Remainder of protocol to be abstracted from patient's hospital medical records.

3. Was there an acute episode of pain, discomfort or tightness in the chest, left arm or jaw within 72 hours of the hospitalization or within 72 hours of the in-hospital event?

[] Yes

[] No

[] Unknown

4. Was the discomfort or pain diagnosed as having a non-cardiac origin?

[] Yes

[] No

[] Unknown

5. Were electrocardiograms (ECGs or EKGs) recorded?

[] Yes

[] No

[] Unknown

If "No" or "Unknown," skip to 6.

Record dates of ECGs and make two copies of FOUR ECG tracings as described below. Send one copy to the ECG Reading Center and attach one copy to this form:

-- If four or fewer tracings were made, include all tracings.

-- If more than four tracings were made, include:

1. First two codable tracings after admission (ECG#1-First and ECG#2)

2. Last codable tracing prior to discharge or death (discharge tracing) (ECG-Last)

3. Last codable tracing on day 3 (or the first tracing thereafter) following an admission or in-hospital event (ECG#3)

4. The next codable tracing after day 3

-- If the participant is readmitted (transferred) to the ICU/CCU because of a new episode of chest pain, the first codable tracing may be sent.

 

Serum Enzymes

6. Were any cardiac enzyme measurements performed during this admission?

[] Yes

[] No

If "No," skip to end.

7. Did the participant have any active liver disease (cirrhosis, hepatitis, liver cancer, etc.)?

[] Yes

[] No

If "Yes," specify:

_____________________________________________________

8. Is there any evidence of hemolytic disease during this hospitalization?

[] Yes

[] No

9. Is there any mention of the participant having either trauma, a _ procedure, or rhabdomyolysis within one week prior to the measurement of the cardiac enzymes?

[] Yes

[] No

[] Unknown

If "Yes," please specify type of trauma or procedure below.

Date m/d/y: __ / __ / __ __

Type of Trauma or procedure:

__________________________________________

* Please complete ENZYME CHART. *

 

 

10. Myocardial infarction

[] Definite

[] Probable

[] No MI (skip to end)

If “Definite” or “Probable” enter date of MI (MM/DD/YYYY): __ __ / __ __ / __ __ __ __

Criteria

11. Chest Pain

[] Present

[] Absent

12. Cardiac Enzymes

[] Abnormal

[] Equivocal

[] Incomplete

[] Normal

13. ECG Serial Reading (pick one)

[] Evolution of Major Q-Wave

[] Evolution of ST-T Elevation with or without Q-Wave

[] New LBBB

[] Evolution of ST-Depression/Inversion alone

[] Evolution of Minor Q-Wave alone

[] Single ECG with Major Q-Wave

[] Single ECG with LBBB, described as new

[] Absent, Uncodable or Other ECG

14. Procedure-related:

[] Yes, cardiovascular

[] Yes, non-cardiovascular

[] No

Diagnostic Criteria:

Acute, Evolving or Recent MI

Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI:

1. Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following:

  • ischemic symptoms;
  • development of pathologic Q waves on the ECG;
  • ECG changes indicative of ischemia (ST segment elevation or depression); or
  • coronary artery intervention (e.g., coronary angioplasty).

2. Pathologic findings of an acute MI.

Established MI

Any one of the following criteria satisfies the diagnosis for established MI:

1. Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed.

2. Pathologic findings of a healed or healing MI.

Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Download PDF

Personnel and Training Required

An interviewer who is trained to conduct personal interviews with individuals from the general population is required to complete the protocols from the Cardiovascular Health Study (CHS) and the Women's Health Initiative (WHI). The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews.* The interviewer should be trained to prompt respondents further if a "don't know" response is provided.

*There are multiple modes to administer this question (e.g., paper-and-pencil and computer-assisted interviews).

A trained and certified Hospital Record Abstractor is required to complete the protocol from the Multi-Ethnic Study of Atherosclerosis (MESA). This person should be trained to perform medical record and chart abstraction using various hospital records.

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered question, Medical record abstraction

Life Stage:

Adult

Participants:

Cardiovascular Health Study (CHS): >65 years old

Women's Health Initiative (WHI): women ages 50–79 years old*

Multi-Ethnic Study of Atherosclerosis (MESA): ages 45–85 years old

*While this questionnaire was used in a women's study, the Cardiovascular Working Group deems it appropriate to use with men.

Selection Rationale

A combination of four protocols was chosen to obtain sufficient data to assess whether a person had a myocardial infarction. Obtaining a personal history of myocardial infarction and treatment procedures, in combination with medical record abstraction, will provide a high level of specificity and reliability.

Language

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Myocardial Infarction Indicator 2935318 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Myocardial infarct proto 62397-5 LOINC
Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Cardiovascular haHealth Study (CHS). Baseline Medical History Questionnaire. Page 1. Question 1 (source for question 1).

U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Women's Health Initiative (WHI). Form 33D—Medical History Update. Version 4. Question 3.3 (source for question 2).

U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Multi-Ethnic Study of Atherosclerosis (MESA). Hospital Abstraction: Cardiac/Peripheral Vascular Disease (PVD) Form. Questions 15, 17, 27–31 (source for questions 3–9).

U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Multi-Ethnic Study of Atherosclerosis (MESA). Cardiac Review Form. Question 1 (source for questions 10–14 ).

Alpert, J. S., Thygesen, K., Antman, E., & Bassand, J. P. (2000). Myocardial infarction redefined—A consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Journal of the American College of Cardiology, 36(3), 959–969 (source for Diagnostic Criteria).

General References

Ives, D. G., Fitzpatrick, A. L., Bild, D. E., Psaty, B. M., Kuller, L. H., Crowley, P. M., Cruise, R. G., & Theroux, S. (1995). Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study. Annals of Epidemiology, 5, 278–285.

Psaty, B. M., Kuller, L. H., Bild, D., Burke, G. L., Kittner, S. J., Mittelmark, M., Price, T. R., Rautaharju, P. M., & Robbins, J. (1995). Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study. Annals of Epidemiology, 5(4), 270–277.

Protocol ID:

40801

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX040801_Cardiac_Enzyme PX040801120000 Cardiac Enzymes N/A
PX040801_Chest_Discomfort PX040801030000 Was there an acute episode of pain, discomfort or tightness in the chest, left arm or jaw within 72 hours of the hospitalization or within 72 hours of the in-hospital event? Variable Mapping
PX040801_Chest_Discomfort_Non_Cardiac PX040801040000 Was the discomfort or pain diagnosed as having a non-cardiac origin? Variable Mapping
PX040801_Chest_Pain PX040801110000 Chest Pain Variable Mapping
PX040801_ECG_Serial_Reading PX040801130000 ECG Serial Reading (pick one) N/A
PX040801_Electrocardiogram PX040801050000 Were electrocardiograms (ECGs or EKGs) recorded? Variable Mapping
PX040801_Enzyme_Chart_Date PX040801090700 Record all serum enzyme values Date (mm/dd/yy) N/A
PX040801_Enzyme_Chart_Enzyme PX040801090300 Record all serum enzyme values Serum enzyme N/A
PX040801_Enzyme_Chart_Range PX040801090400 Record all serum enzyme values Normal Range N/A
PX040801_Enzyme_Chart_Time PX040801090800 Record all serum enzyme values Time (hh:mm am/pm) N/A
PX040801_Enzyme_Chart_Value_High PX040801090600 Record all serum enzyme values Highest enzyme value N/A
PX040801_Enzyme_Chart_Value_Low PX040801090500 Record all serum enzyme values Lowest enzyme value N/A
PX040801_Ever_Have_Myocardial_Infarction PX040801010000 Has a doctor ever told you that you had a myocardial infarction or heart attack? Variable Mapping
PX040801_Ever_Have_Stent PX040801020000 Have you had an outpatient or day surgery procedure to unblock blocked or narrowed blood vessels of the heart (called a PTCA, coronary angioplasty, stent, or atherectomy)? Variable Mapping
PX040801_Evidence_Hemolytic_Disease PX040801080000 'Is there any evidence of hemolytic disease during this hospitalization? N/A
PX040801_Liver_Disease PX040801070000 Did the participant have any active liver disease (cirrhosis, hepatitis, liver cancer, etc.)? Variable Mapping
PX040801_Liver_Disease_Specify PX040801070100 Did the participant have any active liver disease (cirrhosis, hepatitis, liver cancer, etc.)? If "Yes", specify. Variable Mapping
PX040801_Myocardial_Infarction PX040801100000 Myocardial infarction Variable Mapping
PX040801_Myocardial_Infarction_Date PX040801100100 Myocardial infarction: If 'Definite' or 'Probable' enter date of MI. Variable Mapping
PX040801_Procedure_Related PX040801140000 Procedure-related N/A
PX040801_Serum_Enzyme PX040801060000 Were any cardiac enzyme measurements performed during this admission? N/A
PX040801_Trauma_Before_Enzyme_Measurement PX040801090000 Is there any mention of the participant having either trauma, a surgical procedure, or rhabdomyolysis within one week prior to the measurement of the cardiac enzymes? N/A
PX040801_Trauma_Before_Enzyme_Measurement_Date PX040801090100 Is there any mention of the participant having either trauma, a surgical procedure, or rhabdomyolysis within one week prior to the measurement of the cardiac enzymes? If "Yes," specify date of trauma or procedure. N/A
PX040801_Trauma_Before_Enzyme_Measurement_Type PX040801090200 Is there any mention of the participant having either trauma, a surgical procedure, or rhabdomyolysis within one week prior to the measurement of the cardiac enzymes? If "Yes," specify type of trauma or procedure. N/A
Cardiovascular
Measure Name:

Myocardial Infarction

Release Date:

September 9, 2009

Definition

Measure to assess if patient had a myocardial infarction (heart attack).

Purpose

Myocardial infarction (heart attack) is a leading cause of death for both men and women in the United States, which makes myocardial infarction a prevalent health issue for investigators to study.

Keywords

cardiovascular, myocardial infarction, heart attack, Multi-Ethnic Study of Atherosclerosis, MESA, Cardiovascular Health Study, CHS, Women's Health Initiative, WHI, chest pain, percutaneous transluminal coronary angioplasty, PTCA, coronary angioplasty, atherectomy, hospitalization, coronary stent, thrombolytic therapy, electrocardiogram, ECG, EKG, myocardial ischemia, ST-elevation myocardial infarction, STEMI, anticoagulation, coronary bypass surgery, personal history