QM-2 Inpatient Early Invasive Strategy (Within 24 Hours) in High-Risk NSTEMI Patients This measure seeks to implement a Class I (Level of Evidence A) recommendation in the 2014 AHA/ ACC NSTE-ACS guideline11 that an early invasive strategy should be performed in initially stabilized high-risk patients with NSTE-ACS. The writing committee felt it was best to keep this as a quality measure for many reasons. The writing group acknowledges that early invasive strategy (compared with a delayed invasive strategy) in high-risk NSTE-ACS patients predominantly reduces recurrent ischemia (rather than the hard outcomes of recurrent MI or death). Although this strategy additionally reduces length of stay and costs, it creates a logistical burden on cardiac catheterization labs, especially during weekends. Finally, objective risk stratification by risk scores is usually not available in current registries; thus, ascertaining which patients benefit from early invasive strategy may not be readily feasible. QM-3 Inpatient Therapeutic Hypothermia for Comatose STEMI Patients With Out- of-Hospital Cardiac Arrest This measure seeks to implement a Class I (Level of Evidence B) recommendation in the 2013 ACCF/AHA STEMI guideline12 that therapeutic hypothermia should be started as soon as possible in comatose patients with STEMI and out-of- hospital cardiac arrest caused by VF or VT. The writing committee felt it was best to keep this as a quality measure because of newer controversial data pertinent to the effectiveness, timing, and implementation of therapeutic hypothermia. (Continued) 9 made to reflect the new evidence and updated guideline recom- mendations, to strengthen the measure construct, or to expand the measures to include new proven pharmacotherapies. 3.1.3. New Measures The new measure set includes 4 performance measures and 7 quality measures. Table 6 includes a list of the new measures and their rationale. 