Date
Item
Date of visit
date
C0011008 (UMLS CUI [1])
Patient Study ID
Item
Patient ID
text
C2348585 (UMLS CUI [1])
ECG
Item
ECG done?
boolean
C1623258 (UMLS CUI [1])
Date
Item
Date of ECG
date
C0011008 (UMLS CUI [1])
ECG findings
Item
Any pathologic findings in ECG?
boolean
C0438154 (UMLS CUI [1])
ECG findings
Item
Please specify any pathologic ECG findings
text
C0438154 (UMLS CUI [1])
Item
Did any of the events listed below happen after randomization but before CABG surgery? If yes, please fill in the outcome event form.
text
C1547647 (UMLS CUI [1,1])
C0441471 (UMLS CUI [1,2])
Code List
Did any of the events listed below happen after randomization but before CABG surgery? If yes, please fill in the outcome event form.
CL Item
Myocardial infarction (2)
CL Item
Not applicable (4)
Concomitant Medication
Item
Did the patient take antiplatelet agents the day before surgery?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose from the list below, which antiplatelet drug the patient took
text
C0085826 (UMLS CUI [1])
Code List
Please choose from the list below, which antiplatelet drug the patient took
CL Item
Acetyl salicylic acid (1)
CL Item
Acetyl salicylic acid plus Dipyridamole (3)
CL Item
More than one of the list (4)
Antiplatelet drugs
Item
Please specify which antiplatelet drugs the patient took, if you chose "other" or "more than one"
text
C0085826 (UMLS CUI [1])
Concomitant Medication
Item
Did the patient take any anticoagulants the day before surgery?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose which one of the anticoagulants listed below the patient took.
integer
C0003280 (UMLS CUI [1])
Code List
Please choose which one of the anticoagulants listed below the patient took.
CL Item
Unfractionated heparin IV (1)
CL Item
Full dose LMW heparin (Enoxaparin , Others) (2)
CL Item
Vitamin K Antagonists like Warfarin (Coumadin) (3)
CL Item
More than one of the list (6)
Anticoagulants
Item
Please specify which anticoagulant the patient took, if you chose "other" or "more than one".
text
C0003280 (UMLS CUI [1])
Concomitant Medication
Item
Did the patient take any antihypertensive drugs the day before surgery?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose which one of the antihypertensive drugs listed below the patient took.
text
C0003364 (UMLS CUI [1])
Code List
Please choose which one of the antihypertensive drugs listed below the patient took.
CL Item
ACE inhibitor (1)
CL Item
angiotensin receptor blocker (2)
CL Item
Calcium Antagonist (4)
CL Item
More than one of the list (7)
antihypertensive agent
Item
Please specify which antihypertensive agent the patient took, if you chose "other" or "more than one".
text
C0003364 (UMLS CUI [1])
Concomitant Medication
Item
Did the patient take any lipid lowering agents the day before surgery?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose which one of the antilipemic agents listed below the patient took
text
C0086440 (UMLS CUI [1])
Code List
Please choose which one of the antilipemic agents listed below the patient took
CL Item
More than one (3)
antilipemic agent
Item
Please specify which antilipemic agent the patient took, if you chose "other" or "more than one".
text
C0086440 (UMLS CUI [1])
Concomitant Medication
Item
Any other relevant concomitant medication the patient took the day before surgery?
boolean
C2347852 (UMLS CUI [1])
Concomitant Medication
Item
Please specify what other concomitant medication the patient took
text
C2347852 (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])