I work with Southcoast Health and am in the process of validating reports for the OP-40 STEMI measure. A few questions have come up so far:

1. Our system includes three hospitals. Two of which that do not perform PCI and one that does. When a STEMI patient presents to the two sites with no interventional cardiac services, they are transferred to the hospital that does perform PCI. We do not discharge the patient. In this example, would these patients be measured on door in door out of the transferring facility, OR should it be door to device on the PCI performing facility?

2. For patients who present to the emergency department and have multiple EKGs, where a STEMI is diagnosed on a subsequent EKG, do we still measure door to PCI time or should we be starting with the time the STEMI was diagnosed on the subsequent EKG?

3. Is there an exclusion for patients who have ST elevations on their EKG in the ER, and go to the cath lab but are found to have no significant stenosis, therefore no PCI is performed? Takotsubo cardiomyopathy/myopericarditis, etc.