The chest pain MI registry May case scenario is regarding sequence 7845, first device activation date and time. In this scenario, we have a 56-year-old female with no significant past medical history that presents to the ED on May 5, 2020 at 7 a.m. with a chief complaint of acute onset shortness of breath and chest pain. She has a positive point-of-care troponin with an ECG that is positive for STEMI. The cath lab is emergently activated. The patient arrived in the cath lab at 745. Right femoral access was obtained at 757. After anticoagulants were administered, the interventional guidewire was inserted at 8 a.m. A drug-eluting stent was inserted at 812. However, it was unable to cross the lesion due to the tortuosity of the artery. After multiple attempts with multiple devices, the PCI procedure was aborted. Question, how is sequence 7845, first device activation date and time coded? Is it 1, 5-5-20 at 8-12, 2, leave blank as reperfusion was not achieved, 3, 5-5-20 at 8 a.m., or 4, 5-5-20 at 7-57? Please take a moment to review. The answer is 3. Sequence 7845, first device activation date and time, would be coded 5-5-20 at 8 a.m. In this scenario, a balloon was not inflated, a stent was not deployed, nor was there any additional treatment of the lesion. An angiojet or other thrombectomy aspiration device, laser, rotational atherectomy performed. Therefore, in instances where the lesion cannot be crossed with a guidewire or device, the time of guidewire introduction will be used per the data definition. In this scenario, the abstractor codes as follows, noting a patient-centered reason for delay occur due to the patient's tortuous anatomy. Question, will this patient be included in the numerator for metric 37, first medical contact to device time, no or yes? Please take a moment to review. And the answer is yes. The patient will be included in the numerator for metric 37, first medical contact to device time. The denominator includes patients with pre-admit STEMI who received primary PCI for acute STEMI in which this patient met criteria. Remember, a percutaneous coronary intervention or PCI is the placement of an angioplasty guidewire, balloon, or other device, stent, atherectomy, brachytherapy, or thrombectomy catheter into a native coronary artery or coronary artery bypass graft for the purpose of mechanical coronary revascularization. The numerator includes patients whose time from first medical contact, in this case arrival date and time, to first device activation was 90 minutes or less. This patient arrived on May 5, 2020, at 7 a.m., and first device activation was the guidewire insertion at 8 a.m., which is a difference of 60 minutes. While the patient was noted to have a patient-centered reason for delay, their first device activation time was not greater than 90 minutes, thus the denominator exception does not apply. As this is an and statement, the patient would have to have both a patient-centered reason for delay and a first device activation time of greater than 90 minutes. Thank you for viewing the Chest Pain MI Registry May case scenario.

STEMI

PCI

device activation

metric 37

primary PCI