CHECKLIST QUESTIONNAIRE 2000

	- Do not forget to put your name and full address in the top right corner
	- Add as many comments as feasible (good estimates suffice for the percentages)
	- In case the exact number is not known, please provide best estimate.
	- If estimate cannot be made, please insert ‘NA’ (= data not available).
	- If the number is zero, please indicate ‘0’.

Line x: 	Catheterization center for diagnostic use only: yes or no
Line x: 	Catheterization center for diagnostic and interventional use: yes or no
Line x: 	Number of catheterization rooms at your institution 
Line x: 	Number of diagnostic catheterization operators working independently at your institution
Line x: 	Number of interventional operators working independently at your institution
Line x: 	PCI center at your institution with cardiac surgery: yes or no 
Line x: 	PCI center at your institution with cardiac database: yes or no

Line x: 	Full diagnostic catheterization with coronary angiography, whether or not done in conjunction with other diagnostic studies or PCI, elective isolated PCI also to be counted  
Line x: 	PCI procedures (cases), no matter what instrument used, how many lesions or vessels dilated, whether a diagnostic study was done during the same session, or whether the patient had additional PCI procedures during the same year
Line x: 	PCI procedure involving more than 1 of the 3 coronary territories (LAD, LCX, RCA)
Line x:	PCI during ongoing infarction with or without thrombolysis or aggressive platelet inhibition
Line x: 	PCI procedures done in one session together with the diagnostic study producing the indication
Lines xx: 	In case of several complications, each to be counted separately
Line x: 	Most sensitive definition of infarction used for local statistics (including non-Q infarction) 
Line x:	CABG during hospitalization done as an emergency as a consequence of PCI
Lines xx: 	These procedures contribute to the counts of lines xx-xx. Combined procedures have to be counted once only for each applicable item on lines xx-xx.

An example
A patient has a diagnostic coronary angiogram on day 1, a PCI of the LAD and a directional atherectomy of the RCA on day 2, a control angiogram and repeat PCI of the LAD with implantation of 2 stents on day 3 for which a GP IIb/IIIa antagonist is started before the procedure, and a control angiogram on day 7. On day 9, he has an infarction and emergency surgery and he dies on day 56 without having left the hospital in between.

This patient counts:
-	for coronary angiography (line x) 4 times (day 1, day 2, day 3, and day 7)
-	for PCI (line x) twice (day 2 and day 3)
-	for multivessel PCI (line x) once on day 2
-	for PCI during diagnostic study (line x) once (day 3)
-	for infarction (line x) once (day 9)
-	for emergency CABG (line x) once (day 9); CABG done as an emergency for a (late) vessel occlusion after PCI is counted as emergency CABG although 6 days have passed since the most recent PCI
-	for in-hospital death (line x) once (day 56)
-	for stent implantation (line x) and multiple stents (line x) once each (day 3)
-	for directional atherectomy (line x) once (day 2)
-  for use of platelet glycoprotein IIb/IIIa antagonist (line x) once (day 3)

Again, thank you for your cooperation in this important data collection!