FAQ - 1

Frequently Asked Questions: Adult Cardiac Database Version 2.41 The Society of Thoracic Surgeons National Database Program March 2004 \| Section 1 (10-1400) \| Section 2 (1420-2350) \| Section 3 (2360-4680) \| Section 4 (4760-5690) \| Click on Seq # in this area to go directly to that field in the FAQ. Seq#: 1670, Meds-ACE Inhibitors - CORRECTION TO PREVIOUSLY ANSWERED QUESTION Seq#: 5332, Ace-Inhibitors - Discharge Click Here to see letter from Paul Meehan at DCRI, Accepting Zero Values. For fields pertaining to this letter look for red asterisk in NEW column.
NEW	Date	SeqNo	FieldName	Definition
	9/03		GENERAL QUESTIONS	-Patient has CABG; while still in hospital has thoracic aortic dissection, then reop for bleeding then expires while still in hospital. -Another patient has CABG then reop for bleeding on same day during which time the patient gets another SVG, patient discharged alive. My surgeon thinks that in both these cases, we should complete 2 STS forms for each patient.	The STS is set up to capture only one, primary procedure per admission with any subsequent interventions captured as complications. We realize that some important information will be missed, primarily OR information.
		10	Software Vendor Name	Name (assigned by STS) given to identify software vendor (up to 8 characters).
		20	Software Version	Vendor's software product name and version number identifying the software which created this record (assigned by vendor).
		30	STS Data Version	Version number of the STS Data Specifications/Dictionary, to which each record conforms. It will identify which fields should have data, and what are the valid data for each field. It will likely be the version implemented in the software at the time the data was collected and the record was created. This should be entered into the record automatically by software.
		40	Participant ID	Participant ID is a unique number assigned to each database Participant by the STS. A database Participant is defined as one entity that signs a Participation Agreement with the STS, submits one data file to the harvest, and gets back one report on their data. The Participant ID must be entered into each record. Each Participant's data if submitted to harvest must be in one data file. If one Participant keeps their data in more than one file (e.g. at two sites), then the Participant must combine them back into one file for harvest submission. If two or more Participants share a single purchased software, and enter cases into one database, then the data must be extracted into two different files, one for each Participant ID, with each record having the correct Participant ID number.
		50	Record ID	Unique number that permanently identifies each record in the database. This number can never be changed or reused. Note: Record ID is not, and should not be, the patient's medical record number at site.
		52	Cost Link	Participant specified Cost link id that does NOT include the patient's medical record number as part of the code.
		54	STS Trial Link Number	STS Trial Link Number is a unique number assigned to each STS supported clinical trial. This ID is controlled by assignment of the STS.
		60	Patient ID	This is an arbitrary number (not a recognizable ID like SSN or Medical Record Number) that uniquely and permanently identifies each patient. Once assigned to a patient, this can never be changed or reused. This field is only necessary if the software uses a separate patient table.
		70	Record Complete?	Indicates whether the record data is complete or not. This entry is made by the software data quality check process. This field does not impact a procedure's harvest status.
		80	Patient Last. Name	Patient Last Name
		90	Patient First Name	Patient First Name
		100	Patient M.I.	Patient Middle Initial
		110	Date of Birth	Patient Date of Birth
		120	Patient Age	Patient age in years, at time of surgery. This should be calculated from the date of birth and the date of surgery, according to the convention used in the USA (the number of birthdate anniversaries reached by the date of surgery).
		130	Gender	Patient Gender
		140	Social Security #	Although this is the Social Security Number in the USA, other countries may have a different National Patient Identifier Number. For example in Canada, this would be the Social Insurance Number.
		150	Medical Record Number	Patient medical record number at the hospital where surgery occurred.
		190	Patient ZIP Code	The ZIP Code of the patient's residence. Outside the USA, this data may be known by other names such as Postal Code.
		210	Race	Patient Race
		220	Referring Card-Cardiologist	Referring Cardiologist's Name
		250	Referring Physician	Referring Physician's Name
		280	Hospital Name	The full name of the facility where the procedure was performed.
		282	Hospital ZIP Code	The ZIP Code of the hospital. Outside the USA, this data may be known by other names such as Postal Code.
		284	Hospital State	The State in which the hospital is located.
		290	Payor	Primary Payor
		320	Date of Admission	Date of Admission
		320	Date of Admission	Is this the date the patient comes to the hospital prior to surgery if the patient does not ever go home, or is it the day they are declared an inpatient? We have many surgical patients who come in for their caths as outpatients and then are converted to inpatients when they are admitted for their surgery, but never actually leave the hospital. They never leave the hospital but their status changes.	The date that the patient status changes to an inpatient status is the date for admission. (3-13-02)
		330	Date of Surgery	Date of Surgery
	7/03	330	Date of Surgery	Regarding date of surgery: for surgeries that start on one date and end on another, i.e. starts at 10pm and ends at 2am, is the actual surgery date the date surgery begins or ends?	The date of surgery is the date the patient enters the OR suit.
		340	Date of Discharge	Date of Discharge
				When a patient is transferred to our Rehab unit prior to going home, is this the date of discharge, or is it the date that they actually go home?	The date of discharge would be considered the date they leave the acute care facility. 3-13-02)
				If the date of discharge is calculated from the date that the patient leaves acute status, then is the readmit to the Rehab unit considered a readmission within 30 days? They are considered an inpatient on the Rehab unit.	No, this is not considered a readmit. A readmit is considered to be to the acute care facility. (3-13-02)
		350	Same Day Elective Admit	Patient admitted for scheduled elective procedure on same day as procedure.
		350	Same Day Elective Admit	If someone comes in on Monday for a scheduled heart cath, ends up being admitted and has surgery on Tuesday, would this be a same day elective admission?	The intent in the question is to capture patients who come in (physically) the same day as surgery for an elective procedure. It is not to capture those who were in the hospital the day before which by semantics or admitting they just happen to be formally admitted the same day as surgery. (3-13-02)
*		354	Initial ICU hours	Indicate the number of hours the patient was initially in the ICU post operation. Leave blank if the patient expired in the OR.
				Our patients generally are in the recovery area and then go straight to our telemetry floor. Do we include the recovery area hours as the initial ICU stay or not?	Yes we would include this at this time as it appears you utilize your recovery area as an ICU.(3-13-02)
	6/03			Do the initial ICU hours begin when the patient gets to the open heart recovery area or when the patient leaves the OR in transport?	ICU hours begin when the patient arrives in the ICU or your institutions equivalent to an ICU.
	7/03			Patient involved in a MVA with a subsequent repair of an Aortic Transection. Post-operatively went to the SICU and not the Cardiothoracic surgery ICU. Should we still count the SICU hours as ICU hours?	Yes, count the SICU hours as ICU hours. The intent is to capture critical care environment hours. It does not matter what your institution calls their critical care environment (ICU, CVICU, SICU, anesthesia recovery unit). If the patient is in a critical care environment then the hours need to be coded.
		355	Readmission to ICU	Was the patient readmitted to the Intensive Care Unit after an initial stay? The patient must have been transferred to a step-down or intermediate care ward and then returned to Intensive Care Unit.
*		356	Additional ICU Hours	Indicate the number of additional hours spent in the Intensive Care Unit.
*		357	Total Hrs ICU	Indicate the total number of hours post operation for which the patient was in the ICU. Leave blank if the patient expired in the OR.
		357	Total Hrs ICU	About 25% of our patients are ready to go to a stop down unit and dont because there is no bed available. Also, our patients do not go to the recovery room, making our ICU hours longer than institutions that use the recovery room. Have other institutions encountered this issue?	Yes, this issue has been raised by other users. The definition is intended to mean the total number of hours that the patient requires Acute Care, Critical Care, or ICU Care. If there is a bed availability issue and patient has to stay in the ICU, you need to continue to monitor those hours. It would become very gray in terns of when the actual ICU hours change (i.e. when were the orders written? When did the staff first find out there was no bed?) This is a process issue that needs to be collected and monitored for future improvement. Also, you could track the number of hours the patient was in the ICU just waiting for a bed separately in a custom field, or in a separate database/spreadsheet. The issue of the patient coming to the ICU right from surgery, bypassing the recovery room is very common and does cause some variance in reporting total hours between sites where patients go to recovery first. If your site bypasses the recovery room, you need to count the hours and know that other sites that are set up like yours are reporting the same. (4-19-02)
		400	Weight (kg)	Indicate the weight of the patient in kilograms.
		420	Height (cm)	Indicate the height of the patient in centimeters.
		440	RF-Smoker	A history confirming any form of tobacco use in the past (cigarettes, cigar, tobacco chew, etc.).
		450	RF-Smoker-Current	Patients with a use of tobacco (cigarettes, cigar, tobacco chew etc.) within one month of surgery are considered to be current smokers.
		450	RF-Smoker-Current	The version 2.35 definition for smoking was use of cigarettes within one month of surgery. My understanding was that use of other tobacco products within one month was considered a past smoker. Version 2.41 definition states that any tobacco product use within one month is considered present use. Is this a change to the smoking definition?	The 2.41 definition is not a change in intent, but is now written more clearly. The intent is to capture any tobacco use within 1 month as current use. (4-19-02)
		470	RF-Family History CAD	Whether any direct blood relatives (parents, siblings, children) have had any of the following at age <55: a. Angina b. myocardial infarction (MI) c. sudden cardiac death without obvious cause.
	6/03			How do I answer the question of family history of CAD when the patient is adopted?	Code as no.
	11/03			In regards to family history--the definition reads yes if early onset (<55). I am currently reviewing a chart of a 76 yr old. Her father had first MI in his 60's and died of MI in his 70's. Her mother died at 84 of MI. How can that not be classified as + family history? Those folks probably never doctored like people do today and if they did-did they have the technology to prove they had CAD? I would like to classify this woman as having + family history. What would the correct classification be?	CAD noted prior to age 55 is a much stronger predictor than CAD that occurs and is diagnosed later in life. Later in life CAD is more of an indicator of lifestyle. If your patient's family's CAD was diagnosed after age 55 do not code as "yes" to family history of CAD.
		480	RF-Diabetes	A history of diabetes, regardless of duration of disease or need for anti-diabetic agents.
				How do you code a patient admitted with an elevated blood glucose, no admitting diagnosis of DM, but is treated post-operatively with meds and diet?	Pre-op Diabetes should be NO if there was not a documented history of diabetes pre-op and if the patient was not treated for it pre-operatively. If diabetes is diagnosed during the admission for operation and the patient received treatment for it preoperatively, it should be YES. If the patient did not receive treatment preoperatively despite going home on a new diabetic therapy, this should be No. (3-13-02)
	6/03			Would I capture a patient here that had gestational diabetes?	Do not code unless the patient continued to be treated (diet, oral, insulin) after the gestational period.
		490	RF-Diabetes-Control	Method of diabetic control, at time of intervention. Code the control method patient presented with on admission. Patients placed on a pre-operative diabetic pathway of Insulin drip but at admission were controlled with diet or oral method are not coded as insulin dependent. Choices are: None = No treatment for diabetes. Diet = Diet treatment only. Oral = Oral agent treatment. Insulin = Insulin treatment (includes any combination with insulin).
NEW	1/04	490	RF-Diabetes-Control	The first sentence of this definition refers to coding the diabetic control method "at time of intervention", the second sentence refers to coding the diabetic control method on admission. This particular patient is admitted on oral agents, yet requires sliding scale coverage 3-4 times a day on top of their oral agents for a three day period prior to surgery/intervention. This is not a diabetic pathway pre-operatively ordered. Which control do I capture	I understand your confusion. The intent of this element is to capture the patients long term (chronic) diabetic management therapy. In your example, the patient that has been controlled on oral agents, but then switched to insulin for three days while in hospital, would be coded as oral.
		510	RF-Hyperchol	Whether the patient has a history of hypercholesterolemia diagnosed and or treated by a physician. Criteria can include documentation of: a. TC > 200 b. LDL >= 130 c. HDL < 30 Admission cholesterol > 200 mg/dl.
				If in the H&P it states that the patient has hyperlipidemia, should that be interpreted to mean hypercholesterolemia and choose YES? If the patients total cholesterol level is <200 is the answer NO? If the total cholesterol level is >200, is the answer YES? Does hyperlipidemia=hypercholesterolemia? Also, if the patient is being treated for hypercholesterolemia and the total cholesterol is <200, can we still count hypercholesterolemia as a risk factor?	The definition clearly states that hypercholesterolemia is marked whether the patient has a history of hypercholesterolemia diagnosed and/or treated by a physician. Criteria can include total cholesterol >200, LDL>=130, HDL<30, or admission cholesterol>200. According to this a documented diagnosis of hyperlipidemia would meet the definition for hypercholesterolemia. Also, a patient who is being treated for hyperlipidemia and now presents with normal values would also meet the criteria. (3-13-02)
	4/03			What does TC stand for, total cholesterol or triglyceride?	Total Cholesterol.
	12/03			1. Patient has no history of hypercholesterolemia but is placed on a statin prophylactically due to a strong family history of hypercholesterolemia = code "no" to seq# 510, Hypercholesterolemia 2. Patient has a positive history of hypercholesterolemia (abnormal cholesterol levels). Patient placed on a statin resulting in a reduction of cholesterol levels to more "normal" levels = code "yes" to seq# 510, Hypercholesterolemia. 3. Patient has no history of hypercholesterolemia but is placed on a statin for non-hypercholesterolemia reasons, i.e., anti-inflammatory reasons = code "no" to seq# 510, Hypercholesterolemia
		525	RF-Last Creat Lvl	Most recent prior to day of surgery. A creatinine level should be collected on all patients for consistency, even if they have not prior history. A creatinine value is a high predictor of a patients outcome and used in the Predicted Risk Models.
		530	RF-Renal Fail	Is there a documented history of renal failure? Does the patient have a history of a creatinine > 2.0? Prior renal transplant patients are not included as pre-op renal failure unless since transplantation their creatinine has been or currently is > 2.0.
	9/03	530	RF-Renal Fail	Pt comes to the ER and is diagnosed with an Aortic Dissection and is rushed to surgery. Creatinine on admission is 2.6. No previous history of renal failure documented in the chart. Do you still count this as a history of renal failure even though you know the increased creatinine is due to his recent dissection?	Yes, code as renal failure. This patients pre-op Creatinine meets the criteria for renal failure for the STS.
		560	RF-Renal Fail-Dialysis	Is the patient on dialysis preoperatively?
		570	RF-Hypertension	Does the patient have a diagnosis of hypertension, documented by one of the following: a. Documented history of hypertension diagnosed and treated with medication, diet and/or exercise. b. Blood pressure >140 systolic or >90 diastolic on at least 2 occasions. c. Currently on antihypertensive medication.
		590	RF-CVA	A central neurologic deficit persisting more than 72 hours. (i.e. extremity weakness or loss of motion, loss of consciousness, loss of speech, field cuts).
	6/03	590	RF-CVA	If a patient had a CVA several years prior to the heart surgery and has no residual symptoms, do we code this as a CVA yes then remote?	Code as yes to CVA. If a patient had a CVA in the past, regardless of their current symptoms, this history may have a significant impact on the CT surgery outcome. Yes, code it as a remote interval.
		600	RF-CVA-When	Those events occurring within two weeks of the surgical procedure are considered recent, while all others are considered remote.
		610	RF-Infect Endocard	A patient presenting with valvular disease of infectious etiology with positive blood culture.
	9/03			We have a lot of patients with a history of endocarditis which was treated and required a valve replacement. These same patients are now returning for a second cardiac surgery on a separate valve (eg: endocarditis was on Aortic valve and patient now returns for mitral valve replacement that is not related to endocarditis). Should I classify the patient has having a history of treated endocarditis?	Yes, seq# 610 = yes, seq# 620 = treated.
	11/03			We have many patients return with a history of endocarditis that have required valve replacement in the past. The documentation is inadequate to meet the STS definition of endocarditis but the patients clearly have a history of endocarditis based on the documentation of valve replacement due to endocarditis. I am coding these as no for a history of endocarditis because they do not meet the criteria of the STS definition. Is this correct?	The Definition Task Force states that the intent is to capture patients that have a history, either past or present, of endocarditis in this field, not just to capture those patients that present with current endocarditis requiring valve surgery. Therefore, code "yes" if history of endocarditis, which includes this admission and in the past. For patients with a past history of endocarditis, a positive blood culture is not necessary to code as yes. For those patients presenting with endocarditis on admission, a positive blood culture is necessary to code as yes.
		620	RF-Infect Endocard Type	If the patient is currently being treated for endocarditis, the disease is considered active. If no antibiotic medication (other than prophylactic medication) is being given at the time of surgery, then the infection is considered treated.
		660	RF-Chronic Lung Dis	Specify if the patient has chronic lung disease, and the severity level according to the following classification: No; Mild: FEV1 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy. Moderate: FEV1 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease. Severe: FEV1 <50% predicted, and/or Room Air pO2 < 60 or Room Air pCO2 > 50.
	8/03	660	RF-Chronic Lung Dis	No PFTs performed and yet the physicians are documenting chronic lung disease in medical record.	If no PFTs are obtained, which can be common, look to the remaining STS definition points for chronic lung disease to code this field. *Mild:* ...and/or chronic inhaled or oral bronchodilator therapy. *Moderate:* ...and/or chronic steroid therapy aimed at lung disease. *Severe:* ...and/or room air PO2 < 60 or room air PCO2 >50. If the STS definition points are not met, either with or without PFTs, no matter what the chart says, chronic lung disease should not be coded as "yes".
		670	RF-Immunosuppressive Rx	Use of any form of immunosuppressive therapy (i.e. systemic steroid therapy) within 30 days preceding the operative procedure. Does not include topical applications and inhalers
				Previously, the definition of preoperative steroids excluded the one time dose given in the cath lab. These definitions do not exclude those patients. Do we count a one time dose of steroids as immunosuppressive therapy?	One time doses of medication should not be included. The intent is to capture patients who are using steroids for long term or chronic (3-13-02)
				What are the types of immunosuppressive therapy?	There are 4 classes of drugs considered to be immunosuppressive. They are Corticosteroids, Cytotoxic drugs, Antimetabolites and Cyclosporine. Corticosteroids are included only if taken systemicallynot prn asthma meds. This group of drugs is commonly used to treat recipients of organ transplants, and also can be used in HIV patients. (3-13-02)
	9/03			Can we code this field as "yes" if inhaled steroids are used? The def: leads me to think - yes - "Use of any form of immunosuppressive therapy (i.e. systemic steroid therapy) within 30 days preceding the operative procedure".	The rest of the definition reads, "...does not include topical applications and inhalers or one time systemic therapy." Therefore, inhaled steroids should not be captured as "yes".
		680	RF-Periph Vasc Dis	Whether the patient has Peripheral Vascular Disease, as indicated by claudication either with exertion or rest; amputation for arterial insufficiency; aorto-iliac occlusive disease reconstruction; peripheral vascular bypass surgery, angioplasty, or stent; documented AAA, AAA repair, or stent; positive non-invasive testing documented. Choose one of the following: Yes No
		690	RF-Cerebrovascular Dis	Whether the patient has Cerebro-Vascular Disease, documented by any one of the following: Unresponsive coma > 24 hrs; CVA (symptoms > 72 hrs after onset); RIND (recovery within 72 hrs); TIA (recovery within 24 hrs); Non-invasive carotid test with > 75% occlusion.; or Prior carotid surgery. Choose one of the following: Yes No
		690	RF-Cerebrovascular Dis	In the previous definitions, Carotid Endarterectomy was included under history of cerebrovascular surgery. Is this not considered a risk factor for this version of the definitions? The new definitions only lists non-invasive > 75%?	Yes, it is a risk factor for CV Disease. (3-13-02)
		700	RF-Cerebrovascular Dis Type	What type of Cerebro-Vascular Disease does the patient have? Choose one of the following: Unresponsive coma > 24 hrs. CVA (symptoms > 72 hrs after onset). RIND (recovery within 72 hrs). TIA (recovery within 24 hrs). Non-invasive carotid test with > 75% occlusion. Prior Carotid Surgery.
		710	Prev CV Intervent	Has the patient undergone any previous cardiovascular intervention, either surgical or non-surgical, which may include those done during the current admission. This includes thrombolytic therapy for cardiac indications.
		740	Prior Card Op Req Bypass-#	Prior to this operation, how many cardiac surgical operations were performed on this patient utilizing cardiopulmonary bypass.
		740	Prior Card Op Req Bypass-#	I do not know whether a patients CABG done at another hospital utilized cardiopulmonary bypass. Should Prior Card Op Req Bypass # be coded as a 1, or left blank.	Leave blank if unknown. The committee will review the need to keep this field as a core field in the next spec revision. (3-13-02).
		750	Prior Card Op No Bypass-#	Prior to this operation, how many cardiac surgical operations were performed on this patient without cardiopulmonary bypass.
		760	Prev CAB	Previous Coronary Artery Bypass surgery by any approach.
		770	Prev Valve	Previous surgical replacement and/or repair of a cardiac valve, by any approach.
		940	Prev Oth Card	Any other previous cardiac surgery which traversed the anterior mediastinum, including surgery on the ascending aorta and/or arch.
		1160	PTCA/Ather	Was Percutaneous Transluminal Coronary Angioplasty and/or Coronary Atherectomy done at any time prior to this surgical procedure (which may include during the current admission).
	4/03			Does a PTCA/PCI count if a wire is passed? Or does a PTCA/PCI count if a wire is passed and an angioplasty is done? Some of our opinions from a previous meeting is that STS stated a PTCA/PCI counts if the wire is passed period. Please provide some examples.	A PTCA/PCI procedure counts when the wire is passed across a lesion. Having a PTCA/PCI procedure count has nothing to do with whether or not the actual procedure (inflation with lesion reduction) was performed or the outcome of that procedure. Therefore, you are remembering correctly when you say that in a previous meeting the STS stated that a PTCA/PCI counts if the wire is passed period. Wire could not be passed. Does the procedure count? No Wire passed, Pt. becomes hypotensive, wire removed, procedure not completed. Does the procedure count? Yes Wire passed, wire removed prior to completion of procedure because procedure created wide open MR. Does the procedure count? Yes Wire passed, wire removed after completion of procedure. Procedure created wide open MR. Does the procedure count? Yes
	6/03			Is a percutaneous radiofrequency ablation considered a prior PTCA?	No, ablation does not relate in any way to a coronary artery. Percutaneous Transluminal Coronary is the defining point to PTCA.
		1190	PTCA/Ather Intvl-(PTCA-Surg)	The time between PTCA/Atherectomy and surgical repair of coronary occlusion: <= 6 hours > 6 hours
		1190	PTCA/Ather Intvl-(PTCA-Surg)	Is the PTCA/Athr Intvl field tracking time between the last prior PTCA and CABG? So if a patient had a PTCA in 1984 and a CABG in 2000, would it be marked >6 hours? Or does this field pertain to PTCA/Ather Intvl during the admission of the CABG.	Select yes for any previous PTCA regardless of when, and select the >6 hours option. The time interval should count from the time between the last intervention and the CABG (3-25-02).
		1230	Prev Non Surg-Stent	Did the patient previously have insertion of an intra-coronary stent at any time prior to this surgical procedure (which may include during the current admission)?
	5/03	1230	Prev Non Surg-Stent	Interventional cardiologists at our hospital told me that primary or direct stenting is performed without angioplasty. Is this correct?	Yes. Primary or direct stenting is done without angioplasty. All stent placement does not require angioplasty. Therefore, seq# 1230 would be coded as yes and seq# 1160 would be coded as no.
		1235	Stent Intvl	The time between Stent and surgical repair of coronary occlusion: <=6 hours >6 Hours.
		1240	Thrombolysis	Was Thrombolytic treatment given for cardiac indications at any time prior to this surgical procedure, which may include during the current admission?
		1260	Thrombolysis-Intvl	The time between thrombolysis treatment and surgical repair of coronary occlusion: <= 6 hours > 6 hours.
		1280	Prev Non Surg-Balloon Valv	Was a previous Non surgical Balloon Valvuloplasty performed.
		1340	MI	Patient hospitalized with an MI documented in the medical record. Two of the following four criteria are necessary: a. Prolonged ( > 20 min) typical chest pain not relieved by rest and/or nitrates. b. Enzyme level elevation: either (1) CK-MB > 5% of total CPK; (2) CK greater than 2x normal; (3) LDH subtype 1 > LDH subtype 2; or (4) troponin > 0.2 micrograms / ml. c. Any wall motion abnormalities as documented by LV Gram, Echo, Muga Scan and or EF<45%. d. Serial ECG (at least two) showing changes from baseline or serially in ST-T and/or Q waves that are 0.03 seconds in width and/or > or + one third of the total QRS complex in two or more contiguous leads.
				Many of our patients come to the hospital without the supporting documentation for MI history as specified in the definitions. Clinically these patients would be considered to have a history of an MI if it is documented in the medical record by the cardiologist or the patient reports a history of MI. Does this fall into the STS definition of MI?	No, the patient should meet 2 of the 4 criteria to be considered a MI. Many patients in documentation may have had a past history of a MI but have no wall changes or EKG changes to support the diagnosis. Since the MI occurred in the past you would also not have the duration of pain or enzymes to diagnose this, these patients would be marked No (3-25-02).
				MI Hospitalization: Yes or No Should MI be checked Yes only if the current hospitalization is for MI?	Any history, be it current/same admission prior to surgical intervention or in the medical history regardless of time, if the patient has met two of the four criteria. The intent of the definition and criteria is to identify those patients with a history (recent or remote) of an MI of significant nature as to increase the patients risk or postop morbidity or mortality. (4-19-02)
		1360	MI-When	Time period between the last documented myocardial infarction and surgery.
		1370	Congestive Heart Failure	If patient has symptoms, have they occurred within 2 weeks prior to surgery? This does not include patients with chronic or stable non-symptomatic compensated CHF. Does the patient have one or more of the following: * Paroxysmal nocturnal dyspnea (PND) * Dyspnea on exertion (DOE) due to heart failure * Chest X-Ray (CXR) showing pulmonary congestion. * Pedal edema or dyspnea and receiving diuretics or digoxin.
		1380	Angina	Whether the patient has angina pectoris present leading up to or during the hospitalization within 24 hours prior to surgical intervention.
	6/03	1380	Angina	Is angina only captured if the patient had pain within 24 of surgical intervention?	No, the intent of this field is to capture those patients that have a history of angina prior to surgical intervention. Essentially, if the patient ever had angina, it should be captured here.
		1390	Angina-Type	Indicate the type of angina present within 24 hours of the surgical procedure: Stable: Angina which is controlled by oral or transcutaneous medication. Unstable: The presence of on-going refractory (difficult, complicated, and/or unmanageable) ischemia which necessitates the increase or initiation of angina control therapies that may include: nitroglycerin drip, heparin drip, IABP placement.
	6/03			Where would patients that have a history of angina, but not currently having pain and not currently on medications be captured?	Capture these patients as stable angina type.
	8/03			If a patient has angina within 24 hours of surgery and that pain requires IV nitroglycerin, IV Heparin and IABP etc. to control pain = unstable. If a patient has angina prior to 24 hours before surgery and that pain requires IV nitroglycerin, IV Heparin and IABP etc. to control pain, the pain is controlled with these therapies and the therapies are not changed AT ALL (no increase or decrease of the gtts within 24 hours of surgery and no further angina)= stable. If a patient has angina prior to 24 hours before surgery and that pain requires IV nitroglycerin, IV Heparin and IABP etc. to control pain, the pain is not controlled with these therapies within 24 hours which leads to a change in therapies within 24 hours of surgery (increase and/or decrease of the gtts.)= unstable. If a patient has angina prior to 24 hours before surgery and that pain requires IV nitroglycerin, IV Heparin and IABP etc. to control pain, the pain is controlled with these therapies, no more angina, but for whatever reason there is a change (however slight)in therapies within 24 hours of surgery(increase and/or decrease of the gtts.)= unstable. 1. A patient presents with angina and is started on IV nitroglycerin, IV Heparin and an IABP to control pain. If within 2 days of surgery and up to the time of surgery the patient remains on these treatments, is not having chest pain and no adjustments are needed to the medications to keep the patient pain free, is the patient's angina stable or unstable? Answer: Stable 2. We are still having difficulty interpreting unstable angina. Does this mean the patient does not need to have angina within 24 hours (eg: IABP inserted 25 hours before surgery for angina)? If the patient requires IABP and/or IV NTG to control the angina and the angina is successfully controlled within the 24 hours of surgery, then this would be considered unstable (3-25-02). Answer: In this case, if the therapies that were initiated at 25 hours prior to surgery were successful, such that within 24 hours of surgery patient experienced no further angina and no change in therapies = stable. If the therapies that were initiated at 25 hours prior to surgery were successful, but patient experiences angina again within 24 hours of surgery, thus leading to changes in therapies to keep the patient pain free = unstable.
		1400	Angina Unstable Type	If the patient has Unstable Angina, which presentation? * Rest Angina. * New onset exertional angina of at least Canadian Cardiovascular Society Class (CCSC) III in severity. * Recent acceleration in pattern and increase of one CCSC class to at least CCSC Class III. * Variant angina. * Non-Q wave Myocardial Infarction. * Post-infarction angina.