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This included a 6.9% rate of recurrent MI at 12 months (7).

Quality measures are those metrics that be useful for local quality improvement but are not yet appropriate for public reporting or pay for performance programs (uses of performance measures).

For the sake of immediate treatment strategies (e.g., reperfusion therapy), AMI is differentiated into STEMI and NSTEMI, depending on the existence of ST-segment elevation in ≥2 contiguous leads on the presenting ECG.

Acute STEMI equivalent can, however, manifest as: hyperacute T-wave changes, true posterior MI, multilead ST depression with coexistent ST elevation in lead a VR, characteristic diagnostic criteria in the setting of left bundle branch block.

Potential challenges from measure implementation may lead to unintended consequences.

The manner in which challenges are addressed is dependent on several factors, including the measure design, data collection method, performance attribution, baseline performance rates, reporting methods, and incentives linked to these reports.

AMI is also associated with a substantial direct and indirect cost burden, and is classified among the top 10 most expensive hospital principal discharge diagnoses (3).

As indicated in the Third Universal Definition of Myocardial Infarction consensus document published in 2012 (8), AMI is defined by the detection of a rise and/or fall of cardiac biomarkers (preferably cardiac troponin levels) with at least 1 value above the 99th percentile upper reference limit and with at least one of the following: (a) symptoms of ischemia; (b) new or presumed new significant ST-segment–T wave changes or new left bundle branch block; (c) development of pathological Q waves in the electrocardiogram (ECG); (d) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality; (e) identification of an intracoronary thrombus by angiography or autopsy.Importantly, AMI patients who survive the initial event have substantial risk for future cardiovascular events, including recurrent MI, death, heart failure, and stroke.In the PLATO (Platelet Inhibition and Patient Outcomes) trial, the rate of the combined cardiovascular endpoint (vascular death, MI, or stroke) was 11.7% at 12 months among AMI patients treated with aspirin and clopidogrel (7).Given the widespread use of very sensitive assays for markers of myocardial necrosis (e.g., the highly sensitive and specific cardiac troponin [c Tn] biomarkers) and advanced imaging modalities, very small amounts of myonecrosis unrelated to ischemia can be detected (e.g., heart failure, renal failure, myocarditis, pulmonary embolism).Our measures also do not apply to these myocardial injury events, which should be differentiated from true AMI events.In the summer of 2015, the Task Force convened the writing committee to begin the process of revising the existing set of performance measures for adult patients hospitalized with ST-Elevation and Non–ST-Elevation Myocardial Infarction (STEMI and NSTEMI, respectively), that was last updated in 2008 (2).