Continued 28 Inhibitor at Discharge Receptor Inhibitor Prescribed at Discharge Measure description: Percentage of patients, age 18 y, hospitalized with AMI who are prescribed an appropriate P2Y12 receptor inhibitor at hospital discharge. Numerator Patients with AMI who are prescribed an appropriate P2Y12 receptor inhibitor at hospital discharge receptor inhibitors include: Clopidogrel, prasugrel, or ticagrelor in PCI-treated patients Clopidogrel or ticagrelor in medically treated patients Clopidogrel or prasugrel in STEMI patients receiving fibrinolytic therapy Denominator All patients with AMI Denominator Exclusions Patients age <18 y Patients who leave against medical advice Patients who die during hospitalization Patients who are on comfort care measures only or hospice Patients who are transferred to another hospital for inpatient acute care Denominator Exceptions Documentation of a medical reason for not prescribing a P2Y12 receptor inhibitor at hospital discharge (eg, allergy or intolerance to each of the three P2Y12 receptor inhibitors, oral anticoagulant therapy at discharge, active bleeding, patients with planned CABG procedure done after discharge) Documentation of a patient reason for not prescribing a P2Y12 receptor inhibitor at hospital discharge Patient currently enrolled in a clinical trial related to AMI and involving new antiplatelet therapies Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry) Attribution Measure reportable at the facility or provider level Care Setting Inpatient Rationale Coronary heart disease with atherosclerotic plaque disruption (eg, rupture, erosion, ulceration) and superimposed platelet-rich thrombus formation are the main pathophysiological mechanisms causing MI (type 1 or spontaneous MI). Dual antiplatelet therapy has become the mainstay treatment strategy after AMI. Aspirin inhibits the formation of thromboxane A2, a potent stimulator of platelet aggregation, and is the first-line therapy for AMI. 