Therapeutic hypothermia should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), including patients who undergo primary PCI.192 194 (Class I, Level of Evidence: B) ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; LBBB, left bundle branch block; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction; VF, ventricular fibrillation; and VT, ventricular tachycardia. Appendix A. Continued 37 Short Title: QM-4: Aldosterone Antagonist at Discharge QM-4: AMI: Aldosterone Antagonist Prescribed at Discharge Measure description: Percentage of eligible patients, age 18 y, hospitalized with AMI, who are prescribed an aldosterone antagonist at hospital discharge. Numerator Eligible* patients with AMI who are prescribed an aldosterone antagonist at hospital discharge *Eligible AMI patients for an aldosterone antagonist are patients with no contraindications who are already receiving an ACE inhibitor and beta blocker, and who have an EF 40%, and either HF or diabetes mellitus (aldosterone antagonists are appropriately used when the ACE inhibitor and/or beta blocker cannot be used or tolerated). 