Stent For Life Egypt

Dear Committee Doctor, kindly fill in the following data: The sheet containing data about your centre: AMI questionnaire: CRF Proposal (to be filled once) السيد الدكتور عضو اللجنة برجاء ملأ البيانات التالية الملف اللذى يحتوى على المعلومات الخاصة بالمركز التابع لسيادتكم (‫يتم ملأه مرة واحدة فقط) AMI questionnaire: CRF Proposal

Application for pilot center Stent For Life Egypt

	Center Name	(University/Hospital)
	Case Responsability of	(Prof./Dr.)
	Operator	(Prof./Dr.)
	Case Data entry by	(Prof./Dr.)

1. Identification of the site
	Hospital
	Address
	Contact Physician
	Number of interventional cardiologists
2. Cath lab information
	Number of cath labs
	Number of IC
	Numer of cathlab nurses
	Number of cathlabs available (24/7)
3. Coronary interventional activity
	Number of coronary angiographies
	Number of total procedures/interventions
	Number of interventions just with balloon
	Number of thrombolysis
	Number of total stents used
4. Interventional Activity in AMI
	Number of total procedures/interventions	Primary PCI
		Rescue PCI
		Facilitated PCI
	How many AMI patients undergo pPCI (%)
	Door-balloon time	min (From Hospital door to Balloon)
	Number of aspirations
	Number of procedures just with balloon
	Number of procedures with stent
	# stents used	# BMS
		# DES
		# GW
		# BDC
	# procedures without predilatation
	Security Question	3 + 0 =

Application for pilot center Stent For Life Egypt