Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
A M I S Acute Myocardial Infarction in Switzerland AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions Version 01.2014 Inclusion criteria: • Patients who had symptoms within the last 48 hours at hospital admission with a discharge clinical diagnosis of acute myocardial infarction or • Patients who suffered an acute myocardial infarction in hospital during a hospitalization for other reasons All patients with initial suspicion of acute myocardial infarction at hospital hospital admission regardless of admission mode (emergency room, cath. cath lab.,, intensive care unit, another ward) should be considered for inclusion in the AMIS Plus registry. Acute myocardial infarction definition: 1. Characteristic ischemic symptoms 2. ECG changes indicating new ischemia (ST-T (ST T changes or new left bundle branch block) or developing pathological Q-waves Q 3. A dynamic increase or decrease in biomarker or troponin (I or T) levels above the individual hospital cut-off off for MI. The internationally accepted guidelines guidelines for troponin levels are set at least one value above the 99th percentile of the upper reference limit (URL). (URL) Cut-off off levels for either total creatine kinase (CK) or creatine kinase MB fraction (CK-MB) (CK at least twice the upper limit of normal Patients can also be categorized as having ST-segment ST segment elevation MI (STEMI) or non-STEMI non (NSTEMI) based on initial ECG findings: • STEMI includes evidence of clinical and laboratory findings as described above and ST-segment ST elevation and/or new left bundle branch b block on the initial ECG • NSTEMI includes patients with ischemic symptoms, ST-segment ST segment depression or T-wave T abnormalities in the absence of ST-elevation ST on the initial ECG Filling out the questionnaire: Data can be either entered online at www.amis-plus.ch www.amis -> “Data Entry” ->”AMIS >”AMIS Online Questionnaire” (recommended) or the paper questionnaire can be filled out and posted to the AMIS Plus Data Center. Page 1 AMIS Plus Questionnaire Data Entry Instructions Please pay attention to the following points: • Completeness: If data are unobtainable write “unknown” in the corresponding comments box. • Special cases, ambiguities when filling out the questionnaire: Please use the comments box for online entry or write directly on the paper questionnaire. • Transfer: If the patient was transferred for percutaneous coronary intervention (PCI) and then transferred back to your hospital, this should be treated as 1 case for the entire hospitalization duration. • Follow-up: Please complete the patient follow-up section at the end of the questionnaire and keep the patient’s signed consent form in the patient’s hospital file. • Paper questionnaire: Please write clearly in capital letters. If you have any questions please ring the AMIS Plus Data Center, Telephone 044 634 48 30 (MonThurs 09:00-12:00 / 13:30-17:00) or send an email to [email protected]. Contact: University of Zurich Institute of Social and Preventive Medicine AMIS Plus Data Center Hirschengraben 84 CH-8001 Zurich Tel: +41 (0)44 634 48 30 Fax:+41 (0)44 634 49 86 e-mail: [email protected] website: www.amis-plus.ch Page 2 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions AMIS DATA ENTRY IDENTIFICATION Hospital Each participating hospital receives its own official four-letter code. This code appears automatically when entering data online. Patient ID number The ID number is a number assigned by the hospital, which enables the physician to clearly identify the patient and find the specific hospital record again, in combination with the admission date. hcri AG set number (nr) / code The hcri set nr and code concerns hcri hospitals only. The hcri set nr is obligatory and must be filled out without exception. hcri provides questionnaires with pre-printed hcri nrs. The hcri code is optional as it serves internal hospital purposes only. Please contact hcri if you have any questions. Physician ID The person completing the questionnaire must not always be a physician. The Physician ID and password are both provided by the Data Center to enable online data entry. Please contact the AMIS Plus Data Center ([email protected]) for your personal user name and password Date of data entry The date the paper questionnaire was completed. This date is entered automatically by online entry. PATIENT AT ADMISSION Date of birth Mandatory field. Gender Mandatory field. Weight Rounded up to the nearest kilogram. Height In centimeters. Insurance coverage Does the patient have basic or (semi-)private insurance? Symptoms at admission Mandatory field. Please tick whether the symptoms that led to this hospital admission were typical or atypical for acute myocardial infarction. • Pain Mandatory field. Please tick if the patient was in pain. If the patient received painkillers before admission and was therefore not in pain at admission, please tick that the patient was in pain. If Page 3 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions the patient was unable to answer this question, e.g., patient was intubated, please tick not applicable. • Dyspnea Please tick whether the patient had dyspnea (shortness of breath). Symptom onset date and time Date and time of symptom onset refer to the time the symptoms of this acute myocardial infarction event occurred leading to this hospitalization with pain lasting longer than 30 minutes. Time of occurrence is normally before admission. (If patient had an AMI in hospital whilst being hospitalized for a different complaint please note this in the comments box). Time can be approximate. If unknown, please note this in the comments box. Early symptoms appearing days before the actual event should be noted in the comments box. Time of first medical contact leading to hospitalization Prior to hospital admission this first medical contact could be with a family or emergency doctor, or another hospital if the patient was transferred. If such a medical contact took place, please note the date and time otherwise the admission time will be defined as time of first medical contact. Direct transportation with telemetric ECG transmission to PCI center Please indicate whether the ECG was telemetrically transmitted directly to the PCI center by the emergency doctor or emergency services to trigger cath lab activation for patient arrival by ambulance. This also applies to pre-hospital activation without ECG transmission. Admission date and time to this hospital Date (mandatory field) and time of patient arrival to your hospital. Transfer Please tick whether the patient was transferred to your hospital. If yes, please indicate from which hospital (mandatory field) the patient was transferred. Condition Killip classification Killip classification measures the severity of heart failure after myocardial infarction (Killip and Kimball; Am J Card 1967; 20:457-64). Patients are ranked by Killip class: • I: no clinical signs of heart failure • II: crackles, S3 gallop and elevated jugular venous pressure • III: frank pulmonary edema • IV: cardiogenic shock – hypotension (systolic<90mmHg) and evidence of peripheral vasoconstriction (oliguria, cyanosis, sweating). ECG on admission Mandatory field. Please tick all changes on the initial ECG. Other ECG deviations should be noted in the comments field. If there are no new changes or ECG is normal please tick the corresponding option. Page 4 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions Location of ischemic region Please tick the ischemic regions. If none found, tick undetermined. Heart rhythm Mandatory field. Only one answer possible. If patient has a pacemaker,tick paced rhythm. If not listed, please specify. Vital signs Blood pressure levels and heart rate from the first medical contact can be given if these are more informative. Systolic blood pressure Systolic blood pressure measured at admission. Diastolic blood pressure Diastolic blood pressure measured at admission. Heart rate: Heart rate measured at admission. Admission diagnosis Please choose one of the following: STEMI: acute myocardial infarction with ST-elevation NSTEMI: acute myocardial infarction without ST-elevation LBBB-MI: acute myocardial infarction with new left branch bundle block Others: please specify. REPORTED HISTORY Resuscitation prior to arrival at hospital? Mandatory field. If resuscitation was performed (also in previous hospital if transferred), please tick which kind: cardiopulmonary (mechanical) reanimation and/or cardioversion/defibrillation Regular medication Tick each drug the patient has been taking daily or regularly at the time of admission. If the specific drug is unknown, e.g., anti-hypertensive drug, please note this in the comments field. Comorbidities (Charlson Index) Mandatory field. The comorbidities are documented in accordance with the Charlson Index (Charlson ME et al. J Chronic Dis 1987;40:373-83). Please tick whether or not comorbidities exist. Take all listed comorbidities (as defined below) into account. Please note any further relevant comorbidites in the comments field. • Myocardial infarction: All patients with at least one definite or probable MI, these patients were hospitalized and had ECG and/or enzyme changes. • Cardiac insufficiency: Patients with stress or paroxysmal nocturnal dyspnea who take digitalis, diuretics or afterload reducing drugs. This does not include patients on medication if there is no Page 5 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions • • • • • • • • • • • • • • • • • • change in symptoms or improvement in clinical findings. NYHA III and IV correspond to dyspnea during walking on the flat or at rest. Peripheral vascular disease: Patients with intermittent claudication, post-bypass status due to arterial circulatory disorder, gangrene or acute arterial occlusive disease, untreated thoracic or abdominal aortic aneurysm of at least 6cm in diameter. Cerebrovascular disease: Patients with a history of a cerebrovascular insult with few or no residuals as well as patients with transient ischemic attacks. Hemiplegia: Monolateral paresis/plegia, independent of its origin. Dementia: Patients with chronic cognitive deficits. Chronic lung disease: Patients with at least one hospitalization due to decompensated COPD in the past. This also includes patients with dyspnea at rest in spite of treatment, those with permanent oxygen therapy, CO2 retention as well as those with PO2 at rest below 50mmHg. Connective tissue disorder: Patients with systemic lupus erythematosus, polymyositis, mixed connective tissue disease, polymyalgia rheumatica and moderate to severe rheumatic arthritis. Peptic ulcer disease: Patients who have been treated for peptic ulcer disease including those who had bleeding ulcers. Diabetes: Patient was treated with insulin or oral anti-diabetics but not diet alone. Diabetes with target organ damage: Diabetics with neuropathy, angiopathy, kidney disease and other manifested target organ damage. Mild liver disease: Patients with increased transaminase levels less than twice the upper normal limit. Moderate liver disease: Patients with increased transaminase levels above twice the upper normal limit. Severe liver disease: Patients with coagulopathy and/or ascites. Moderate to severe renal disease: Patients with a serum creatinine of at least 260 micromol/l (3mg%). Malignant neoplasm: Patients with solid malignant tumors without metastases but with initial treatment during the last five years (e.g., breast, colon, bronchial). Leukemia: Patients with acute and/or chronic myeloid leukemia, acute and/or chronic lymphatic leukemia and polycythemia vera. Lymphoma: Patients with e.g., Hodgkin’s disease, lymphosarcoma, Waldenström’s macroglobulinemia and myeloma (plasmacytoma). Metastatic solid tumor: Patients with metastatic solid tumors (e.g., breast, colon, bronchial). AIDS (stage C): Patients with definite or probable AIDS, ie., AIDS-related complex. Care Please indicate if the patient lives in a retirement or nursing home. Please indicate whether the patient receives homecare, e.g. through a nursing service, family members etc. Past history Ischemic heart diseases Mandatory field. Please tick if patient previously had angina pectoris, a myocardial infarction (AMI), coronary artery bypass grafting (CABG) and/or percutaneous coronary intervention (PCI). Please state the date(s) of all previous PCI(s). These data help to identify re-hospitalizations. Page 6 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions Risk factors Tick each documented or treated risk factor. • Family history Is there a family history of ischemic heart disease in a first-degree relative younger than 60 years? • Arterial hypertension Does this patient have a diagnosed history of hypertension and has this been treated or not? Please check that your answer corresponds with your answers for regular medication. • Hyperlipidemia Does this patient have a history of dyslipidemia and has this been treated or not? Please check that your answer corresponds with your answers for regular medication. • Diabetes mellitus Does this patient have a history of diabetes mellitus and has this been treated? If yes, please tick whether the patient was treated with oral antidiabetics and/or insulin. If diabetes was newly diagnosed in hospital please tick “yes” and “untreated”. • Smoking History confirming cigarette smoking: current smoker: has smoked at least 100 cigarettes (5 packs) in his life and is currently smoking, former smoker: stopped smoking cigarettes more than 1 year before this admission, never smoker: never smoked more than 100 cigarettes (5 packs) or more. • Alcohol or drug consumption • Regular alcohol intake? Regular alcohol intake: at least 1-2 drinks/day on at least 4 days/week. Please tick whether or not the patient drank more than 2 drinks per day. • Cocaine consumption? Please tick whether or not the patient consumed cocaine in any form during the previous month or months. • Anabolics or other lifestyle drugs? Please tick whether or not the patient ever consumed anabolic steroids or other lifestyle drugs (psychoactive substances such as cannabis, ecstasy, GHB, speed, LSD). Please specify in the comments field following. IMMEDIATE THERAPY Initial therapeutic strategy Mandatory field. Please note the first therapeutic strategy intended. This does not have to correspond with the therapy actually performed. • Primary PCI, emergent: Was PCI the first planned choice of therapy? This is usually within 24 hours of symptom onset. • Invasive strategy (within 48h): Was PCI the planned therapeutic strategy within 48 hours? • PCI facilitated (before catheter laboratory): Treatment with lysis and/or GPIIb/IIIa antagonist before PCI. • Thrombolysis with immediate transfer for angiography: Was thrombolysis the first planned choice of therapy with immediate transfer for angiography? • Thrombolysis without immediate transfer for angiography: Was thrombolysis the first planned choice of therapy without immediate transfer for angiography? Page 7 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions • Primary conservative treatment, angiography planned: Was conservative therapy the first planned choice of therapy along with a planned angiography? • Conservative treatment, elective angiography if problems: Was conservative therapy the first planned choice of therapy with angiography as an option in case of additional problems? • Primary palliative/symptomatic therapy: Was palliative and/or symptomatic therapy the first planned strategy? This only includes patients who were NOT connected to a monitor after transfer from ICU. IF YES, please write why the patient was treated with palliative therapy. Reperfusion: Thombolysis / PCI Mandatory field. Please tick whether or not the patient received reperfusion (restoration of blood flow to a blocked vessel) by thrombolysis or PCI. If not, please tick the most important reason. Thrombolysis Mandatory field. Please tick whether or not thrombolysis was performed. If thrombolysis was performed in your hospital, please note the date (mandatory field) and starting time of thrombolysis. If performed in another hospital please state which hospital (mandatory field). Coronary angiography Mandatory field. Please tick whether or not coronary angiography was performed. If only a coronary angiography and no PCI was performed, please complete the questions concerning location of procedure, date and starting time of procedure, angiographic findings, left ventricular ejection fraction and then proceed to immediate drug therapy. Percutaneous Coronary Intervention (PCI) Mandatory field. Please tick whether PCI was performed. PCI is a more general term than the formerly used PTCA (percutaneous transluminal coronary angioplasty) and also includes interventions such as stenting. Reason for performing PCI Please tick whether PCI was the first strategy (emergent), an invasive strategy (within 48h), primary PCI for stent thrombosis, rescue PCI after unsuccessful thrombolysis, rescue PCI after primary conservative therapy or elective (optional) PCI. If PCI was the first strategy, it is normally performed within 24 hours of symptom onset. Please state reasons for any time deviations in the comments field. Location of procedure (Coronary angiography/PCI) Please tick where coronary angiography/PCI was performed and state where if in another hospital. Date and starting time of procedure (Coronary angiography/PCI) Date (mandatory field) and starting time of coronary angiography/PCI, defined as the time of the patient’s first automatic arterial blood pressure measurement in the heart catheter laboratory. This is normally after hospital admission. Starting time is obligatory if performed in your hospital. Please note if a transferred patient received a coronary angiography/PCI before admission to your hospital. Page 8 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions Vascular access route Please tick if the initial vascular access route was femoral or radial and then tick if the final vascular access route for PCI was femoral or radial. Angiographic findings Using the current results please tick whether one, two or three vessels and/or the left main stem were affected. If there were no pathological angiographic abnormalities please tick no angiographic abnormalities. Left ventricular ejection fraction Tick the corresponding left ventricular ejection fraction. Only one choice is possible. If only coronary angiography but no PCI was performed please now proceed to the question on immediate drug therapy. Culprit vessel Please tick the vessel responsible for the infarct-related lesion. If other, please specify. • Collaterals to culprit vessel persist Please tick if the collaterals to culprit vessel persist. (if available) • TIMI flow of culprit vessel at the start of PCI Please tick the TIMI flow before the start of PCI. (if available) 0 = no antegrade flow beyond a coronary occlusion I = minimal flow beyond the occlusion, filling of the distal coronary bed is incomplete II = delayed or sluggish antegrade flow with complete filling of the distal territory III = normal flow which fills the distal coronary bed completely • TIMI flow at the end of PCI Please tick the TIMI flow at the end of PCI. (see above) Vessel treated Tick which vessel was treated. Multiple answers are possible. In case more than one PCI was performed during hospitalization, use the data from the first one. Please note details on further PCIs in comments field. PCI with stent Mandatory field. If a stent was implanted, please note the type of stent. • Bare-metal (e.g., Abbott Multi-Link, B. Braun Coroflex Blue, Biotronik Pro-Kinetik, etc.) • Drug-eluting (e.g., Abbott Xience, Boston Scientific Promus, Medtronic Resolute, etc.) • Biodegradable polymer-based drug-eluting (e.g., Biosensors Biomatrix, Biotronik Orsiro, Boston Scientific Synergy, Terumo Nobori, etc.) • Polymeric bioresorbable scaffolds (e.g., Abbott Absorb™) • Metallic bioresorbable scaffolds (e.g., Biotronik DREAMS) Multiple answers are possible. Please state in the comments field if stent type is unknown. Specify number of stents. Drug-eluting balloon Please tick if a drug-eluting balloon was used. Page 9 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions PCI complications Please tick if any of these complications arose whilst performing PCI. If myocardial infarction occurred after PCI, e.g., Stent thrombosis or occlusion of one of the branches, then re-infarction must be ticked in the section “hospitalization” Adjunctive techniques Please tick whether or not a distal protection device and/or thrombus aspiration were also used during PCI. Mechanical circulatory support Please tick whether an intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (LVAD), Impella® and/or extracorporeal membrane oxygenation (ECMO) was necessary during PCI. Immediate drug therapy Please tick whether each medication was administered or not within 24 hours after admission. This also includes emergency medication administered before admission, as well as medication administered by the transferring hospital if the patient was transferred. If the patient was transferred to a PCI center and subsequently transferred back, then the medication administered in the PCI center should also be listed if administered within 24 hours. Please state if medication was not given according to guidelines due to contraindication. If a coronary artery bypass grafting (CABG) was planned or performed, only take into account the medication given prior to the operation. LABORATORY PARAMETERS Please check all the laboratory results available and measured in your hospital and in the case of transferred patients in the transferred hospital. Please take care with the parameter units. If different from the ones given in the questionnaire, please specify. If a CABG was performed only take into account the laboratory results prior to the operation. • Elevated cardiac markers at admission Please tick whether the cardiac markers CK, CK-MB and/or troponin were elevated or not. • Glycemia Please note the glycemia level at admission in mmol/l. • Creatinine Please note the creatinine level at admission in µmol/l. • Hemoglobin Please note the hemoglobin level at admission in g/dl. • White blood cell count Please note the white blood cell count per volume unit at admission. • Copeptin Please note the copeptin level if available. • Maximum CK Please note the highest CK level available in IU/I. • Maximum CK-MB Please note the highest CK-MB level available in IU/l or µg/l. Page 10 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions • Was the troponin level above your hospital cut-off for MI? Mandatory question. Please tick yes or no. • Troponin T Please note the highest troponin T level available in µg/l. • Troponin I Please note the highest troponin I level available in µg/l • Total Cholesterol Please note the total cholesterol level within 24 hours of chest pain onset in mmol/l. • HDL Cholesterol Please note the HDL cholesterol level within 24 hours of chest pain onset in mmol/l. • CRP Please note the CRP level at admission in mg/l. • BNP Please note the BNP level in pg/ml. • NT-ProBNP Please note the NT-ProBNP level in pg/ml. HOSPITALIZATION If a CABG was performed during this hospitalization, this section concerns the time prior to the operation. Complications Mandatory fields. Please tick each complication that occurred during this hospitalization in your hospital or in another hospital in the case of transferred patients. • Cardiogenic shock: should only be ticked if it occurred during hospitalization and not at admission where it is then entered under the Killip classification. • Re-infarction: includes stent thrombosis. • Cerebrovascular event: includes transient ischemic attacks (TIA). • SIRS = systemic inflammatory response syndrome. • Bleeding: Please tick localization. Please define the bleeding by using the BARC score (BARC – The Bleeding Academic Research Consortium)* : BARC Type 0: no evidence of bleeding BARC Typ 1: bleeding that is not actionable (pertaining to out-patients and not applicable to AMIS) BARC Type 2: any overt, actionable sign of hemorrhage (e.g., more bleeding than would be expected for a clinical circumstance) BARC Type 3a: Overt bleeding plus hemoglobin drop of 3 to <5g/dL. Any transfusion with overt bleeding BARC Type 3b: Overt bleeding plus hemoglobin drop ≥ 5g/dL. Cardiac tamponade. Bleeding requiring surgical intervention. Bleeding requiring intravenous vasoactive agents. BARC Score 3c: Intracranial hemorrhage. Intraocular bleed compromising vision. BARC Type 4: CABG-related bleeding (not applicable to AMIS). BARC Type 5: fatal bleeding. *Standardized Bleeding Definitions for Cardiovascular Clinical Trials: A Consensus Report From the Bleeding Academic Research Consortium. Mehran et al. Circulation. 2011;123:2736-2747 Page 11 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions Therapeutic interventions: Please tick each intervention performed during this hospitalization. Performed diagnostic / therapeutic procedures Please tick whether or not each procedure was performed during the hospitalization or planned for a later date. • Coronary angiography Please tick whether coronary angiography (or PCI) was performed or planned in your hospital or another hospital. Please note the number of coronary angiographies performed during the entire hospitalization (also externally). • Echocardiography Please tick whether or not echocardiography was performed or planned for a later date. If performed, please note the date of the first echocardiography during this hospitalization and note the left ventricular ejection fraction level. • Stress test Please tick whether a stress test was performed or planned for a later date. This includes stress test, stress echo or stress test with isotopes. If performed please tick if ischemia was found. • MRI stress test Please tick whether a MRI stress test was performed or planned for a later date. If performed please tick whether there was myocardial viability. • Electrophysiology study (EPS) Please tick whether an invasive EPS was performed or planned. • Computer tomography (CT) Please tick whether a coronary CT was performed or planned. • Coronary artery bypass grafting (CABG) Please tick whether CABG was performed or planned. Intensive care unit • Number of days spent in the intensive care unit If patient was in ICU, please note the number of days the patient spent in ICU. If the patient was less than 24 hours in ICU please note the number of hours spent there. • SAPS II score (if available) Please note the SAPS II Score (Simplified Acute Physiology Score) usually calculated in every ICU (Le Gall et al. JAMA 1993, 270:2957-63). Intermediate care unit • Number of days spent in the intermediate care unit If patient was in an intermediate care unit please note the number of days the patient spent there. 24 hours or less count as 1 day but only whole hours are taken into account, i.e., 24.5 hours=1 day but 25 hours=2 days. This also includes the days the patient was monitored using telemetry once back on the ward. DISCHARGE Survival Mandatory field. Please tick whether the patient survived or not and proceed accordingly. Page 12 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions IF SURVIVAL “YES” »Discharge • Date of discharge Mandatory field. Please note the date of discharge from your hospital. • Destination Mandatory field. Please tick destination at discharge. Choose only one answer. If rehabilitation as out-patient and home apply, please only tick rehabilitation as out-patient. If the patient is transferred to another hospital please note to which hospital. Please specify if the patient went to a different destination. • Clinical diagnosis Mandatory field. Please tick the appropriate clinical diagnosis. Please be sure that: (a) the diagnosis corresponds to the inclusion criteria (see page 1), (b) biomarker levels are above your hospital cut-off level for MI. If in doubt please comment in the space provided. • Type of myocardial infarction according to the universal definitions Please tick the type of myocardial infarction in accordance with Thygesen K et al. Eur Heart J 2007; 28(20): 2525-38. Type 1: Spontaneous MI (plaque rupture and/or erosion) Type 2: Secondary MI (spasm, anemia, arrhythmia, hyper/hypotension) Type 3: Sudden cardiac death Type 4a: Periprocedural PCI (>3x99th percentile of troponin or CK) Type 4b: Stent thrombosis (>3x99th percentile of troponin or CK) Type 5: Periprocedural CABG (>5x99th percentile of troponin or CK) Drugs at discharge • Total number of different drugs at discharge Please count each and every drug at discharge in your hospital. • Cardiovascular medication at discharge Please tick each cardiovascular medication the patient did or didn’t receive at discharge with the corresponding yes or no answer. Please state if medication was not given according to guidelines due to contraindication. • Other medication at discharge Please tick each medication the patient did or didn’t receive at discharge with the corresponding yes or no answer. IF SURVIVAL “NO” Death • Date of death • Cause of death Mandatory fields. If the patient died during this hospitalization please fill out date of death and cause of death. Page 13 University of Zurich, AMIS Plus Data Center AMIS Plus Questionnaire Data Entry Instructions • Clinical Diagnosis Mandatory field. Please tick the appropriate clinical diagnosis. Please be sure that: (a) the diagnosis corresponds to the inclusion criteria (see page 1), (b) biomarker levels are above your hospital cut-off level for MI. If in doubt please comment in the space provided. • Type of myocardial infarction according to the new universal definitions Please tick the type of myocardial infarction in accordance with Thygesen K et al. Eur Heart J 2007; 28(20): 2525-38. Type 1: Spontaneous MI (plaque rupture and/or erosion) Type 2: Secondary MI (spasm, anemia, arrhythmia, hyper/hypotension) Type 3: Sudden cardiac death Type 4a: Periprocedural PCI (>3x99th percentile of troponin or CK) Type 4b: Stent thrombosis (>3x99th percentile of troponin or CK) Type 5: Periprocedural CABG (>5x99th percentile of troponin or CK) PATIENT FOLLOW-UP Was the patient asked to participate in the follow-up? Mandatory field. Please tick if the patient was asked to take part in the follow-up interview? IF YES: Did the patient give his/her formal consent to a follow-up interview? Please tick whether the patient signed the patient consent form. Patient consent forms can be downloaded in PDF at the AMIS Plus Website. The signed consent form remains with the medical records of the patient. (Please do not send these to the AMIS Plus Data Center) IF NO: Why wasn’t the patient asked? If the patient wasn’t asked to participate in the follow-up please tick the reason why. First Name and Surname of Patient: Once the consent form has been signed please note the first name and surname of patient. Tel. Nr of Patient and/or Relative: Please note the landline and mobile numbers of patient. Relatives can also be contacted. Important Tips Concerning Follow-up: The 3- and 12-Month follow-up interviews are normally carried out by the AMIS Plus Data Center Team. This also includes patients from European countries. If desired, hospitals will be granted access to perform their own follow-ups. The follow-up data are merged with the data from the AMIS Plus Questionnaire in the AMIS Plus Data Center. Page 14 University of Zurich, AMIS Plus Data Center