The chest pain MI inclusion criteria for version 3.1 aligns with the fourth universal definition of MI. The chest pain MI registry is designed to provide participating centers feedback on the care and outcomes of patients with possible acute coronary syndrome, extending from low-risk chest pain to acute myocardial infarction. Patients greater than or equal to 18 years of age are included in the registry when a qualifying cardiac diagnosis is made on discharge. The registry has four qualifying cardiac classifications. STEMI and STEMI type 1, unstable angina and low-risk chest pain. Patients who meet the exclusion criteria are excluded and are not entered into the registry. The exclusion criteria include only the following. Transfer patients with an arrival time at the outside facility sequence 1, 2, 4, 2, 6 to arrival time at the receiving facility sequence 3, 0, 0, 1, of greater than 24 hours are not included in the registry. An exception is an in-hospital STEMI occurring at the receiving facility or the current facility. End STEMI patients with MI type 2 non-thrombotic are not included in the registry. The final diagnosis by the cardiologist is used to determine exclusion. Acceptable exclusion documentation includes the diagnosis of end STEMI and at least one of the following. Type 2 MI, supply-demand mismatch, coronary embolism, coronary vasospasm, spontaneous coronary artery dissection or SCAD and Takotsubo cardiomyopathy. Additional exclusion criteria include once revascularization has occurred, PCI or CABG, then the patient is excluded from any subsequent hospital receiving the patient. Patients arriving for scheduled procedure at this facility, elective cath or surgeries are not included unless an in-hospital STEMI occurs. Note, if the in-hospital STEMI is an intra or post elective PCI procedure, these patients are not included in the registry. Patient type STEMI seeks to capture patients with a clinical diagnosis of STEMI with either revascularization such as PCI, thrombolytics, CABG, for STEMI and or the following definition is met. Detection of a rise and or fall of cardiac troponin with at least one value above the 99th percentile upper reference limit and at least one of the following. Symptoms of acute myocardial ischemia, new or presumed new significant ST segment elevation consistent with myocardial infarction, development of pathological Q waves, imaging evidence of new loss of viable myocardium or new regional wall motion abnormalities, in a pattern consistent with an ischemic etiology, identification of an intracoronary thrombus by angiography including intracoronary imaging. STEMI non-thrombotic mechanisms seek to capture when the pathophysiological mechanisms attributed to a non-atherosclerotic atherosclerotic MI are present. To warrant choosing a selection, clear documentation must be in the current medical record to select one of the following causes. Coronary embolism, coronary vasospasm, spontaneous coronary artery dissection or SCAD, Takotsubo cardiomyopathy, and other. Selection of other is chosen only when there is no documentation of coronary embolism, coronary vasospasm, spontaneous coronary artery dissection, Takotsubo cardiomyopathy, and when there is specific documentation of type 2 MI or supply-demand mismatch. NSTEMI type 1 seeks to capture patients with the clinical diagnosis of NSTEMI, and the following definition is met. The detection of a rise and or fall of cardiac troponin with at least one value above the 99th percentile upper reference limit within 24 hours of arrival and at least one value above the 99th percentile upper reference limit. Symptoms consistent with myocardial ischemia, new ischemic ECG changes, development of pathological Q waves, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology, or identification of intracoronary plaque rupture or erosion. Please note in the absence of a troponin elevation above the 99th percentile, the patient is deemed to have unstable angina. Unstable angina seeks to capture patients with the clinical diagnosis of unstable angina and the definition of NSTEMI or STEMI is not met. Low-risk chest pain seeks to capture patients who present with chest pain. Chest pain can be described as pressure, tightness, burning, squeezing, or indigestion that may represent myocardial ischemia. The evaluation must include at a minimum an EKG and one troponin. The definition of unstable angina and NSTEMI or STEMI is not met. Patients may have undergone subsequent testing but cannot have undergone a PCI during the same episode of care. The STEMI setting seeks to capture the timing of the STEMI. The pre-admits STEMI is selected when the STEMI occurred pre-hospital or any time prior to an order for admission. The in-hospital STEMI is selected when the STEMI occurred after an order for admission, meaning the diagnostic ECG occurred after cardiac or non-cardiac admission orders were written. Admission orders for inpatient status are the line in the sand when determining the STEMI setting. Orders for observation status do not qualify as admission orders. It is important to note the only requirement for inclusion for the in-hospital STEMI is the clinical diagnosis of STEMI. The highest cardiac classification value is coded in sequence 1, 2, 3, 6, 0 patient type. An example, a patient presents with chest pain with negative cardiac enzymes and a low risk stratification score. The ED physician prepares to discharge the patient as low risk chest pain. Prior to discharge, the patient's chest pain exacerbates and another set of troponins are obtained with values above the 99th percentile. At the conclusion of care, the patient is diagnosed with an end STEMI, meeting all the patient type criteria. Thus, sequence 1, 2, 3, 6, 0 patient type is coded as an end STEMI, despite their initial diagnosis of low-risk chest pain. To review, sequence 1, 2, 4, 4, 7 STEMI setting seeks to capture the STEMI setting of the patient. The line in the sand is the order for admission. When the STEMI occurs prior to the order for admission, then pre-admit is selected. When the STEMI occurs after a cardiac or non-cardiac order for admission is written, then in-hospital STEMI is selected. It is important to note when STEMI is the highest cardiac classification, then any subsequent STEMI is captured in sequence 1, 2, 3, 4, 4 episode events by coding yes to myocardial infarction to identify the re-infarction. The only exception to coding the highest cardiac classification in sequence 1, 2, 3, 6, 0 patient type is when revascularization is attempted, whether successful or failed. Then the relevant cardiac classification is coded in sequence 1, 2, 3, 6, 0 patient type. The subsequent MI event is captured in episode events as a myocardial infarction. An example, the patient presents with chest pain is diagnosed with an end STEMI with all criteria met and a PCI is performed. The patient then has recurrent chest pain. The ECG obtained reveals ST elevation and a clinical diagnosis of STEMI is made. This patient is coded as an end STEMI in sequence 1, 2, 3, 6, 0 patient type and the subsequent STEMI is captured and identified in the episode event section by selecting yes to myocardial infarction.

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