The staff of the NCDR™ has been working diligently on an updated cath lab module, v3. The process began in the fall of 2002 when dozens of participants provided feedback regarding improvements and enhancements of our current cath lab module, version, 2.0c. This feedback was reviewed along with our notes about definition and/or coding discrepancies, frequently asked questions, and our goals for improving the database. The staff of the NCDR™ reviewed data elements and definitions from other Data Standards (such as the American College of Cardiology Key Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients with Acute Coronary Syndromes), Registries (including the Society for Thoracic Surgery, New York State, Michigan, National Registry for Myocardial Infarction, Crusade and Grace), and Guidelines (such as PCI, Acute MI, Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction). In addition, the ACC and the STS met in January to align and map as many elements and definitions as possible. The ACC and STS mapping consensus includes: 38 elements mapped in definition and coding 10 elements mapped in definition only (coding does not map due to timing of data collection)

The NCDR™ Science and Clinical Support Committee conducted several discussions and meetings from February to July to finalize the upgrade. Key objectives of the upgrade include: Provide an optional “Minumum Data Set” for Diagnostic Catheterization Develop a new table structure to allow us to update the database and accommodate new technologies; Era of Stents and other new intracoronary devices Closure devices to minimize vascular complications Use of new medications to improve patient outcomes Add manufacturer-specific codes for intracoronary devices; closure devices; and medications; Map elements and definitions to the STS Cardiac Surgery Database; Add parent/child relationships and “housekeeping” elements for easier data entry and analysis. Provide “non-harvested” fields such as patient and physician name, and patient social security number and date of birth to conform with HIPAA regulations. Add elements to capture stenosis in coronary artery bypass grafts; Add new elements to align and assess compliance with ACC guidelines (such as recurrent/ongoing ischemia; smoking cessation counseling; cardiac rehab referral); Refine type (includes Seattle Angina Questionnaire) and timing (1 month and 1 year) of Follow-Up Data; Provide additional risk adjusted outcomes;

The committee deleted several elements from v2 including: All calculated fields (i.e. procedure success); Canadian Clinical Classification; Date of previous valvular surgery; Cardiopulmonary bypass during the cath lab visit; Dominance and pulmonary hypertension as diagnostic cath findings; Arrhythmia and unplanned CABG as adverse outcomes.

Other modifications include: Time period from symptom onset to admission (previously called ACS time period) only required for MI patients; Indications for PCI now includes Primary PCI, Rescue PCI, Facilitated PCI and NonSTEMI/Unstable Angina as choices; Indications for PCI include optional calculation of door to door to balloon time for transfer patients; Lesion risk has been simplified to “non-high” or “high” risk lesions; Troponin values have been added based on participant requests (post procedure) Creatinine levels have been added pre and post procedure (if available) to evaluate renal function.

When the committee’s work was complete, the NCDR™ released the final module to vendors in August of 2003 for certification.

Back to Top