Patient Study ID
Item
Patient ID
text
C2348585 (UMLS CUI [1])
Date of hospital admission
Item
Date of hospital admission
date
C0011008 (UMLS CUI [1,1])
C0184666 (UMLS CUI [1,2])
pseudonymized copy
Item
Pseudonymized copy enclosed?
boolean
C3858753 (UMLS CUI [1])
Medical history
Item
Medical history and findings
boolean
C0262926 (UMLS CUI [1])
Item
Clinical severity of heart failure (NYHA-Classification)
text
C1275491 (UMLS CUI [1])
Code List
Clinical severity of heart failure (NYHA-Classification)
CL Item
I Normal physical capacity, asymptomatic (1)
CL Item
II symptoms under physical exertion (2)
CL Item
III symptoms under mild physical exertion (3)
CL Item
IV symptoms at rest (4)
Item
Angina pectoris
text
C0002962 (UMLS CUI [1])
Code List
Angina pectoris
CL Item
I. Ordinary physical activity does not cause angina (1)
CL Item
II. Slight limitation of ordinary activity (2)
CL Item
III. Marked limitation of ordinary activity (3)
CL Item
IV. Inability to carry out any physical activity without discomfort - angina syndrome may be present at rest (4)
Item
Myocardial infarction
text
C0027051 (UMLS CUI [1])
Code List
Myocardial infarction
CL Item
Yes, within last 48 hours (1)
CL Item
Yes,within past 21 days (2)
CL Item
Yes, longer than 21 but no longer than 91 days ago (3)
CL Item
Yes, more than 91 days ago (4)
CL Item
Yes but date of event unknown (8)
Item
Cardiogenic shock
text
C0036980 (UMLS CUI [1])
Code List
Cardiogenic shock
CL Item
Yes, within last 48 hours (1)
CL Item
Yes, within past 21 days (2)
CL Item
Yes, longer than 21 days ago (3)
CL Item
Yes, but date of event unknown (8)
Item
Resuscitation
text
C0007203 (UMLS CUI [1])
CL Item
Yes, within last 48 hours (1)
CL Item
Yes, within past 21 days (2)
CL Item
Yes, longer than 21 days ago (3)
CL Item
Yes, date of event unknown (8)
Artificial ventilation
Item
Patient is on artificial respiration
boolean
C0035205 (UMLS CUI [1])
Item
Pulmonary Hypertension
integer
C0020542 (UMLS CUI [1])
Code List
Pulmonary Hypertension
Item
Cardiac rhythm
integer
C0232187 (UMLS CUI [1])
CL Item
Normal sinus rhythm (1)
CL Item
Atrial fibrillation (2)
Item
Patient wears an artificial cardiac pacemaker/defibrillator
text
C0030163 (UMLS CUI [1])
Code List
Patient wears an artificial cardiac pacemaker/defibrillator
CL Item
Yes,Pacemaker (1)
CL Item
Yes,Defibrillator (2)
Item
ASA Classification
integer
C1531480 (UMLS CUI [1])
Code List
ASA Classification
CL Item
A normal healthy patient (1)
CL Item
A patient with mild systemic disease (2)
CL Item
A patient with severe systemic disease (3)
CL Item
A patient with very severe systemic disease that is a constant threat to life (4)
CL Item
A moribund patient (5)
Item
LVEF
integer
C0428772 (UMLS CUI [1])
CL Item
bad or less than 30% (1)
CL Item
average or 30-50% (2)
CL Item
good or more than 50% (3)
Item
coronary angiography findings
text
C0085532 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
Code List
coronary angiography findings
CL Item
no coronary heart disease (0)
CL Item
1-vessel disease (1)
CL Item
2-vessel disease (2)
CL Item
3-vessel disease (3)
Item
Significant left main stem disease?
text
C0856739 (UMLS CUI [1])
Code List
Significant left main stem disease?
CL Item
Yes equal to or more than 50% (1)
Previous PCI
Item
Previous percutaneous coronary intervention?
boolean
C1532338 (UMLS CUI [1])
Item
Previous heart surgery or aortic surgery
integer
C0018821 (UMLS CUI [1,1])
C0205156 (UMLS CUI [1,2])
Code List
Previous heart surgery or aortic surgery
CL Item
number of interventions unknown, but at least one (8)
Item
Other current infection
text
C0009450 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Code List
Other current infection
CL Item
Mediastinitis (1)
CL Item
broncho-pulmonary infection (3)
CL Item
oto-laryngologic infection (4)
CL Item
florid endocarditis (5)
CL Item
thoracic wound infection (7)
CL Item
pleural empyema (8)
CL Item
infection of venous puncture site (9)
CL Item
wound infection of lower extremities (11)
CL Item
HIV infection (12)
CL Item
Hepatitis b or C (13)
CL Item
other wound infection (18)
CL Item
other general infection (88)
Item
Diabetes mellitus
integer
C0011849 (UMLS CUI [1])
Code List
Diabetes mellitus
CL Item
yes, only set dietary (1)
CL Item
yes, medical controlled (2)
CL Item
yes, insulin dependent (3)
CL Item
yes, untreated (4)
Item
Arterial vascular disease
integer
C0497252 (UMLS CUI [1])
Code List
Arterial vascular disease
Item
peripheral arterial disease
text
C1704436 (UMLS CUI [1])
Code List
peripheral arterial disease
Item
Carotid artery disease
text
C0007273 (UMLS CUI [1])
Code List
Carotid artery disease
Item
Aortic aneurysm
integer
C0003486 (UMLS CUI [1])
Code List
Aortic aneurysm
Item
Other arterial diseases
text
C0852949 (UMLS CUI [1])
Code List
Other arterial diseases
Item
Lung diseases
integer
C0024115 (UMLS CUI [1])
CL Item
Yes COPD with chronic medication (1)
CL Item
Yes COPD without chronic medication (2)
CL Item
Yes, other lung disease (8)
Item
Neurologic diseases
integer
C0027765 (UMLS CUI [1])
Code List
Neurologic diseases
CL Item
Yes,CNS cerebrovascular (hemorrhage,ischemia) (1)
CL Item
Yes,CNS other (2)
CL Item
Yes, peripheral (3)
CL Item
Yes, combination (4)
Item
Modified Rankin Stroke Scale score if you answered the previous question with CNS-1
text
C2984908 (UMLS CUI [1])
Code List
Modified Rankin Stroke Scale score if you answered the previous question with CNS-1
CL Item
No symptoms at all (0)
CL Item
No significant disability despite symptoms; able to carry out all usual duties and activities (1)
CL Item
Slight disability; unable to carry out all previous activities but able to look after own affairs without assistance (2)
CL Item
Moderate disability; requiring some help but able to walk without assistance (3)
CL Item
Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance (4)
CL Item
Severe disability; bedridden, incontinent, and requiring constant nursing care and attention (5)
Item
Preoperative dialysis
text
C0011946 (UMLS CUI [1])
Code List
Preoperative dialysis
Creatinine, Serum
Item
Serum creatinine preoperative
float
C0201976 (UMLS CUI [1])
Serum creatinine
Item
Serum creatinine preoperative
float
C0201976 (UMLS CUI [1])
Date of completion
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature by investigator
text
C1519316 (UMLS CUI [1])
Name of Investigator
Item
Name of Investigator
text
C0008961 (UMLS CUI [1])
