Time for a DIagnostic Paradigm Shift From ST-elevation/Non-ST-elevation to OCClUsion/Non-occLusion Myocardial infarcTion
Phase: NA
Conditions: Myocardial Infarction, Myocardial Ischemia, Acute Coronary Syndrome, Diagnosis, Morality
Sponsor: Başakşehir Çam & Sakura City Hospital

Ti me f or a Dia g n ostic Para di g m S hift Fr o m 
S T E MI/ N S T E MI t o O MI/ N O MI
( DI F O C C U L T- 3)
N C T 0 6 5 7 0 7 5 9
J u ne 2 9t h, 2 0 2 4

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
Ki mli k Bil gil eri (I d e ntifi c ati o n)
St u d y I D #
__________________________________
N ati o n al I D #
__________________________________
H a s t h e p ati e nt b e e n e x cl u d e d ?
E v et
H a yır
T h e r e a s o n f or e x cl u si o n
A n alt er n ati v e c a u s e f or tr o p o ni n el e v ati o n
Pr e g n a n c y or s u s pi ci o n of pr e g n a n c y
R e p erf u s e d b y t hr o m b ol yti c t h er a p y i n st e a d of P CI
R ej e cti o n or wit h dr a w al of c o n s e nt
U n a bl e t o r etri e v e pr e- P CI E C G s
Ot h er
If ot h er i s c h o s e n, pl e a s e e x pl ai n.
( Pl e a s e bri efl y e x pl ai n t h e r e a s o n f or e x cl u si o n.)
__________________________________
N a m e a n d s ur n a m e
__________________________________
( e. g.; J o h n D o e)
A g e
__________________________________
G e n d er
M al e 
F e m al e
B o y
(i n c e nti m et er s)
__________________________________
Kil o
(i n kil o gr a m s)
__________________________________
P h o n e n u m b er
( R e q uir e d f or f oll o w- u p. E. g..; 0 5 3 2 5 1 0 9 7 9 8, 0 2 1 6
__________________________________
2 8 3 3 8 3 8)
S e c o n d p h o n e n u m b er (if p o s si bl e)
( R e c o m m e n d e d f or f oll o w- u p. E. g.; 0 5 3 2 5 1 0 9 7 9 8, 0 2 1 6  
__________________________________
2 8 3 3 8 3 8)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
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DIFOCCULT 3
Page 1
Randomizasyon (Randomization)
Study ID#
__________________________________
Center
Ankara Etlik City Hospital
Antalya City Hospital
Bagcilar Training and Research Hospital
Basaksehir Pine and Sakura City Hospital
Dr. Siyami Ersek Thoracic and Cardiovascular
Surgery Training and Research Hospital
Erzurum Ataturk University, Faculty of Medicine
Eskisehir Osmangazi University
Eskisehir City Hospital
Kartal Kosuyolu High Specialization Education and
Research Hospital
Kütahya Health Sciences University
Marmara University, Pendik Training and Research
Hospital
Mehmet Akif Ersoy Training and Research Hospital
Mugla Sitki Kocman University
Necmettin Erbakan Meram Faculty of Medicine
Sirnak State Hospital
Tokat Gaziosmanpasa University Hospital
Van Training and Research Hospital
Van Yuzuncu Yil Faculty of Medicine
Randomization date
(Enrollment date)
__________________________________
Study arm
(According to the team on duty)
STEMI/NSTEMI
OMI/NOMI
Ön tanı
(Working diagnosis that caused to proceed to angiography or admission [whichever is the first]. The discharge
diagnosis may not be necessarily with the preliminary diagnosis.)
ST-segment elevation MI (STEMI)
non-ST-segment elevation MI (NSTEMI)
Other
Any "very-high risk" NSTEMI feature ?
Hemodynamic instability or cardiogenic shock
Acute heart failure due to ischemia
Life-threatening ventricular arrhythmias or
cardiac arrest
Mechanical complications (ischemic VSD, acute
ischemic mitral regurgitation etc.)
Refractory or recurrent chest pain despite medical
therapy
Dynamic ST-T wave changes, especially with
intermittent ST-segment elevation
None of above
DIFOCCULT-3 Trial 
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Ön tanı
(Working diagnosis that caused to proceed to angiography or admission [whichever is the first]. The discharge
diagnosis may not be necessarily with the preliminary diagnosis.)
Occlusion MI (OMI)
Non-occlusion MI (NOMI)
Other
Any "high risk" feature NOMI ?
Hemodynamic instability or cardiogenic shock
Acute heart failure due to ischemia
Life-threatening ventricular arrhythmias or
cardiac arrest
Mechanical complications (ischemic VSD, acute
ischemic mitral regurgitation etc.)
None of above
Please explain
(Unstable angina, suspicious but nondiagnostic ECG,
__________________________________
cat lab availability, pre-planned angiography etc.)
Informed consent form
(Downloadable from this link, if required.)
[Attachment: "Onam.pdf"]
Upload the signed informed consent.
(Only signature page is required. Keep the original.)
Since the patient is excluded, you do not need to fill this form. 
(If you think this is an error, please check your answer for "Has the patient been excluded ?" on the first form
(Identification).)
DIFOCCULT-3 Trial 
Condifential 
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pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
Ö z g e ç mi ş ( M e di c al Hi st or y)
St u d y I D #
__________________________________
H y p ert e n si o n
( A v er a g e bl o o d pr e s s ur e > 1 4 0/ 9 0 m m H g or u s e of
a nti h y p ert e n si v e m e di c ati o n)
E v et 
H a yır
Di a b et e s
( F P G > 1 2 6 m g/ d L f or t w o ti m e s or H b A 1 c > % 6. 5 or u s e of
a nti di a b eti c m e di c ati o n)
E v et 
H a yır
D y sli pi d e mi a
( L D L > 1 6 0 m g/ d L or u s e of a nti h y p erli pi d e mi c dr u g)
E v et 
H a yır
A cti v e s m o ki n g
( S m o ki n g hi st or y i n t h e l a st o n e y e ar)
E v et 
H a yır
C hr o ni c ki d n e y di s e a s e
( G F R < 6 0 ml/ mi n/ 1. 7 3 m 2 k n o w n or s u p p o s e d t o b e
l o n g er t h a n 3 m o nt h s)
E v et 
H a yır
Pri or m y o c ar di al i nf ar ct
( D o c u m e nt e d di a g n o si s or i m a gi n g e vi d e n c e of a n ol d
[ > 1 m o nt h] m y o c ar di al i nf ar ct) 
E v et 
H a yır
Pri or p er c ut a n e o u s c or o n ar y i nt er v e nti o n
( D o c u m e nt e d hi st or y or i m a gi n g e vi d e n c e of a pri or
c or o n ar y i nt er v e nti o n) 
E v et 
H a yır
Pri or c or o n ar y art eri al b y- p a s s gr afti n g
( D o c u m e nt e d hi st or y or i m a gi n g e vi d e n c e of a pri or
C A B G) 
E v et 
H a yır
Si n c e t h e p ati e nt i s e x cl u d e d, y o u d o n ot n e e d t o fill t hi s f or m. 
(If y o u t hi n k t hi s i s a n err or, pl e a s e c h e c k y o ur a n s w er f or " H a s t h e p ati e nt b e e n e x cl u d e d ?" o n t h e fir st f or m
(I d e ntifi c ati o n).)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
R a n d o mi z a s y o n ( R a n d o mi z ati o n)
St u d y I D #
__________________________________
C e nt er
A n k ar a Etli k Cit y H o s pit al
A nt al y a Cit y H o s pit al
B a g cil ar Tr ai ni n g a n d R e s e ar c h H o s pit al
B a s a k s e hir Pi n e a n d S a k ur a Cit y H o s pit al
Dr. Si y a mi Er s e k T h or a ci c a n d C ar di o v a s c ul ar
S ur g er y Tr ai ni n g a n d R e s e ar c h H o s pit al
Er z ur u m At at ur k U ni v er sit y, F a c ult y of M e di ci n e
E s ki s e hir Cit y H o s pit al
K art al K o s u y ol u Hi g h S p e ci ali z ati o n E d u c ati o n a n d
R e s e ar c h H o s pit al
K üt a h y a H e alt h S ci e n c e s U ni v er sit y
M ar m ar a U ni v er sit y, P e n di k Tr ai ni n g a n d R e s e ar c h
H o s pit al
M e h m et A kif Er s o y Tr ai ni n g a n d R e s e ar c h H o s pit al
M u gl a Sit ki K o c m a n U ni v er sit y
N e c m etti n Er b a k a n M er a m F a c ult y of M e di ci n e
Or d u St at e H o s pit al
S a nli urf a M e h m et A kif I n a n Tr ai ni n g a n d R e s e ar c h
H o s pit al
Sir n a k St at e H o s pit al
T o k at G a zi O s m a n P a s a U ni v er sit y H o s pit al
U mr a ni y e Tr ai ni n g a n d R e s e ar c h H o s pit al
V a n Tr ai ni n g a n d R e s e ar c h H o s pit al
V a n Y u z u n c u Yil F a c ult y of M e di ci n e
R a n d o mi z ati o n d at e
( E nr oll m e nt d at e)
__________________________________
St u d y ar m
( A c c or di n g t o t h e t e a m o n d ut y)
S T E MI/ N S T E MI
O MI/ N O MI
Pr eli mi n ar y di a g n o si s
( W or ki n g di a g n o si s t h at c a u s e d t o pr o c e e d t o a n gi o gr a p h y or a d mi s si o n [ w hi c h e v er i s t h e fir st])
S T- s e g m e nt El e v ati o n M y o c ar di al I nf ar cti o n ( MI) Crit eri a:
( 1) N e w J- p oi nt el e v ati o n a c c or di n g t o t h e f oll o wi n g c ut- off s i n t w o c o n s e c uti v e l e a d s:
* I n V 2- V 3, ≥4 0 m al e s  ≥ 2 m m; < 4 0 m al e s  ≥2. 5 m m, f e m al e s ≥1. 5 m m,
* i n all ot h er l e a d s ≥1 m m
* (i n cl u d e s V 7- 9 S T- s e g m e nt el e v ati o n or V 1- 4 S T- s e g m e nt d e pr e s si o n f or " p o st eri or" MI)
( 2) a p e a k tr o p o ni n e x c e e di n g 9 9. p er c e ntil e wit h a c h ar a ct eri sti c i n cr e a s e a n d d e cr e a s e (r etr o s p e cti v e)
( 3) a cli ni c al pi ct ur e c o m p ati bl e wit h a c ut e c or o n ar y s y n dr o m e.
S T E MI s h o ul d b e s el e ct e d if pr o c e e d e d t o c at h l a b o nl y wit h 1 st a n d 3r d crit eri a, e v e n if t h e 2 n d crit eri o n i s n ot m et
(r etr o s p e cti v el y).  P ati e nt s m e eti n g o nl y 2 n d a n d 3r d crit eri a s h o ul d b e cl a s sifi e d a s n o n- S T- el e v ati o n m y o c ar di al
i nf ar cti o n. 
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

S T- s e g m e nt el e v ati o n MI ( S T E MI)
n o n- S T- s e g m e nt el e v ati o n MI ( N S T E MI)
Ot h er
A n y " v er y- hi g h ri s k" N S T E MI f e at ur e ?
H e m o d y n a mi c i n st a bilit y or c ar di o g e ni c s h o c k
A c ut e h e art f ail ur e d u e t o i s c h e mi a
Lif e-t hr e at e ni n g v e ntri c ul ar arr h yt h mi a s or
c ar di a c arr e st
M e c h a ni c al c o m pli c ati o n s (i s c h e mi c V S D, a c ut e
i s c h e mi c mitr al r e g ur git ati o n et c.)
R efr a ct or y or r e c urr e nt c h e st p ai n d e s pit e m e di c al
t h er a p y
D y n a mi c S T- T w a v e c h a n g e s, e s p e ci all y wit h
i nt er mitt e nt S T- s e g m e nt el e v ati o n
N o n e of a b o v e
Pr eli mi n ar y di a g n o si s
( W or ki n g di a g n o si s t h at c a u s e d t o pr o c e e d t o a n gi o gr a p h y or a d mi s si o n [ w hi c h e v er i s t h e fir st])
Krit erl er:
( 1) E C G fi n di n g s s u g g e sti v e of a c ut e c or o n ar y o c cl u si o n ( or a n O MI di a g n o si s b y t h e A p p)
( 2) a p e a k tr o p o ni n e x c e e di n g 9 9. p er c e ntil e wit h a c h ar a ct eri sti c i n cr e a s e a n d d e cr e a s e (r etr o s p e cti v e)
( 3) a cli ni c al pi ct ur e c o m p ati bl e wit h a c ut e c or o n ar y s y n dr o m e.
O MI s h o ul d b e s el e ct e d if pr o c e e d e d t o c at h l a b o nl y wit h 1 st a n d 3r d crit eri a, e v e n if t h e 2 n d crit eri o n i s n ot m et
(r etr o s p e cti v el y). P ati e nt s m e eti n g o nl y 2 n d a n d 3r d crit eri a s h o ul d b e cl a s sifi e d a s N O MI. 
O c cl u si o n MI ( O MI)
N o n- o c cl u si o n MI ( N O MI)
Ot h er
A n y " hi g h ri s k" f e at ur e N O MI ?
H e m o d y n a mi c i n st a bilit y or c ar di o g e ni c s h o c k
A c ut e h e art f ail ur e d u e t o i s c h e mi a
Lif e-t hr e at e ni n g v e ntri c ul ar arr h yt h mi a s or
c ar di a c arr e st
M e c h a ni c al c o m pli c ati o n s (i s c h e mi c V S D, a c ut e
i s c h e mi c mitr al r e g ur git ati o n et c.)
N o n e of a b o v e
Pl e a s e e x pl ai n
( S u s pi ci o u s b ut n o n di a g n o sti c E C G, c at l a b
__________________________________
a v ail a bilit y, pr e- pl a n n e d a n gi o gr a p h y et c.)
I nf or m e d c o n s e nt f or m
( D o w nl o a d a bl e fr o m t hi s li n k, if r e q uir e d.)
[ Att a c h m e nt: " O n a m. p df"]
U pl o a d t h e si g n e d i nf or m e d c o n s e nt.
( O nl y si g n at ur e p a g e i s r e q uir e d. K e e p t h e ori gi n al.)
Si n c e t h e p ati e nt i s e x cl u d e d, y o u d o n ot n e e d t o fill t hi s f or m. 
(If y o u t hi n k t hi s i s a n err or, pl e a s e c h e c k y o ur a n s w er f or " H a s t h e p ati e nt b e e n e x cl u d e d ?" o n t h e fir st f or m
(I d e ntifi c ati o n).)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
Ö n c e ki t e d a vi si ( Pri or m e di c ati o n)
St u d y I D #
__________________________________
A s piri n
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
P 2 Y 1 2 i n hi bit or
N o n e
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
Cl o pi d o gr el
Ti c a gr el or
Pr a s u gr el
O A C/ N O A C
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
A C Ei/ A R B
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
A R NI
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
S G L T 2i
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
B et a- bl o c k er
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
C al ci u m c h a n n el bl o c k er
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
M R A
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
L o o p di ur eti c
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
St ati n
( M e di c ati o n s u s e d b ef or e t h e a d mi s si o n)
E v et 
H a yır
Si n c e t h e p ati e nt i s e x cl u d e d, y o u d o n ot n e e d t o fill t hi s f or m. 
(If y o u t hi n k t hi s i s a n err or, pl e a s e c h e c k y o ur a n s w er f or " H a s t h e p ati e nt b e e n e x cl u d e d ?" o n t h e fir st f or m
(I d e ntifi c ati o n).)
DI F O C C U L T- 3 Tri al 
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DIFOCCULT 3
Page 1
Başvuru sırasındaki klinik değişkenler (Clinical
parameters on admission)
Study ID#
__________________________________
Mode of admission
Directly (by themself or by ambulance)
(Directly or by referral)
Referred (from another institution)
NOTE: With regard to the admission to the randomizing
(PCI-capable) center.
Systolic blood pressure on admission
(in mmHg)
__________________________________
Heart rate on admission
(in beats per minute)
__________________________________
Killip class on admission
NOT: Başvurudan randomizasyonun yapıldığı hastane (ana çalışmacının çalıştığı primer PKG merkezi)
kastedilmektedir.
Class 1: No evidence of heart failure
Class 2: Pulmonary rales, S3 or increased jugular venous pressure
Class 3: Overt pulmonary edema
Class 4: Signs of cardiogenic shock (oliguria, cyanosis, pale and clammy skin) or hypotension (SBP< 90
mmHg)
Cardiopulmonary resuscitation before admission
(Need for chest compressions, defibrillation or
intubation before randomization)
Evet
Hayır
Creatinine on admission 
(Just before or after randomization, in mg/dL, e.g.;
__________________________________
1.2)
Hemoglobin on admission
(Just before or after randomization, in g/dL, e.g.;
__________________________________
12.3)
Very-high troponin level for this center is 1000 ng/L
(According to the kit used by this center in ng/L [=pg/mL]. This level suggests a major epicardial coronary artery
occlusion) 
Very-high troponin level for this center is 2400 ng/L
(According to the kit used by this center in ng/L [=pg/mL]. This level suggests a major epicardial coronary artery
occlusion) 
Very-high troponin level for this center is 5000 ng/L
(According to the kit used by this center in ng/L [=pg/mL]. This level suggests a major epicardial coronary artery
occlusion) 
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Troponin on admission
(first troponin in ng/L [=pg/mL], e.g.; 12) 
__________________________________
NOTE: If not taken on admission, can be obtained
during angiography.
If present, second troponin
(second troponin in the ER in ng/L [=pg/mL], e.g.; 12)
__________________________________
Duration of pain
(The duration of the last pain in minutes. If
__________________________________
continuing, calculate the time to ECG from the onset
of last constant pain.)
Intermittent chest pain before MI ?
(Before the last infarct-related pain, did the patient
experience pain episodes in the previous month ?)
Evet
Hayır
Upload the first ECG
(This may not be the diagnostic one. To upload further
ECGs, use additional areas below)
NOTE: Use image files (.jpg, .png, .tiff vb.) or pdf.
or
You can also use report code on PMCardio App
(For example, enter only 6c40a7ab for "Report
6c40a7ab"  on PMCardio App.)
{ekg1_reportno}
*must provide a value.
Time of the first ECG
(The date on ECG as day/month/year and hour:minute)
__________________________________
Upload the second ECG
NOTE: Use image files (.jpg, .png, .tiff vb.) or pdf.
or
You can also use report code on PMCardio App 
(For example, enter only 6c40a7ab for "Report 
6c40a7ab"  on PMCardio App.)
{ekg_reportno_2}
*must provide a value.
DIFOCCULT-3 Trial 
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Upload the third ECG
NOTE: Use image files (.jpg, .png, .tiff vb.) or pdf.
or
You can also use report code on PMCardio App
(For example, enter only 6c40a7ab for "Report
6c40a7ab"  on PMCardio App.)
{ekg_reportno_3}
*must provide a value.
Upload the fourth ECG
NOTE: Use image files (.jpg, .png, .tiff vb.) or pdf.
or
You can also use report code on PMCardio App
(For example, enter only 6c40a7ab for "Report
6c40a7ab"  on PMCardio App.)
{ekg_reportno_4}
*must provide a value.
Upload the fifth ECG
NOTE: Use image files (.jpg, .png, .tiff vb.) or pdf.
or
You can also use report code on PMCardio App
(For example, enter only 6c40a7ab for "Report
6c40a7ab"  on PMCardio App.)
{ekg_reportno_5}
*must provide a value.
Which one of the uploaded ECGs lead to the diagnosis ?
(Anter the number of the diagnostic ECG. If diagnosis
__________________________________
was not based on ECG, enter "0")
Enter the time of this diagnostic ECG 
(Enter the time on the diagnostic ECG as
__________________________________
day/month/year and hour:minute. This may be the same
as the first ECG)
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Was chest pain present during this diagnostic ECG (or
during any of the ECGs, if none of them were
diagnostic) ?
Evet
Hayır
How many minutes is it since the last pain stopped ?
__________________________________
(Enter the duration of pain from the cessation of the
last episode to the ECG, in minutes.)
Since the patient is excluded, you do not need to fill this form. 
(If you think this is an error, please check your answer for "Has the patient been excluded ?" on the first form
(Identification).)
DIFOCCULT-3 Trial 
Condifential 
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pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
E K G m o d ül ü ( E C G m o d ul e) A u dit
St u d y I D #
__________________________________
Y o u ar e vi e wi n g E C G s fr o m t h e p ati e nt wit h t h e r e c or d n u m b er of [r e c or d_i d], w h o i s a [ a g e] y e ar- ol d [ g e n d er]. T hi s
p ati e nt w a s a d mitt e d t o [ m er k e z] o n [r a n d o mi z a s y o n_t ari hi].
T o a c c e s s P M C ar di o A p p: htt p s:// dif o c c ult. p m c ar di o. c o m
T h e fir st pr e- P CI E C G
 [ e k g 1:i nli n e] Q o H i nt er pr et ati o n:
{ e c g m o d ul e_ pr e 1 q o h }
T h e s e c o n d pr e- P CI E C G
 [ e k g 1:i nli n e] Q o H i nt er pr et ati o n:
{ e c g m o d ul e_ pr e 2 q o h }
T h e t hir d pr e- P CI E C G
 [ e k g 1:i nli n e] Q o H i nt er pr et ati o n:
{ e c g m o d ul e_ pr e 3 q o h }
T h e f o urt h pr e- P CI E C G
 [ e k g 1:i nli n e] Q o H i nt er pr et ati o n:
{ e c g m o d ul e_ pr e 4 q o h }
T h e fift h pr e- P CI E C G
 [ e k g 1:i nli n e] Q o H i nt er pr et ati o n:
{ e c g m o d ul e_ pr e 5 q o h }
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
E K G m o d ül ü ( E C G m o d ul e) 1
St u d y I D #
__________________________________
Y o u ar e vi e wi n g E C G s fr o m t h e p ati e nt wit h t h e r e c or d n u m b er of [r e c or d_i d], w h o i s a [ a g e] y e ar- ol d [ g e n d er]. T hi s
p ati e nt w a s a d mitt e d t o [ m er k e z] o n [r a n d o mi z a s y o n_t ari hi].
T o a c c e s s P M C ar di o A p p: htt p s:// dif o c c ult. p m c ar di o. c o m
T h e fir st pr e- P CI E C G
 [ e k g 1:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e s e c o n d pr e- P CI E C G
 [ e k g 2:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e t hir d pr e- P CI E C G
 [ e k g 3:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e f o urt h pr e- P CI E C G
 [ e k g 4:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e fift h pr e- P CI E C G
 [ e k g 5:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
Ar e t h er e a n y d y n a mi c c h a n g e s s u g g e sti v e of O MI i n
Y e s
pr e- P CI E C G s  ?
N o
U n d efi n e d
( D y n a mi c S T- T c h a n g e s, Q w a v e d e v el o p m e nt)
T h e fir st p o st- P CI E C G
 [ p o st p ci_ e k g:i nli n e]
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
P a g e 2
P o st- P CI 2 4 h E C G
 [ p o st e k g 2 4:i nli n e]
P o st- P CI 4 8 h E C G
 [ p o st e k g 4 8:i nli n e]
P o st- P CI 7 2 h E C G
 [ p o st e k g 7 2:i nli n e]
D o e s E C G s h o w e v ol uti o n c o m p ati bl e wit h a c ut e
Y e s
m y o c ar di al i nf ar cti o n  ?
N o
U n d efi n e d
( C h ar a ct eri sti c Q w a v e a n d/ or S T n or m ali z ati o n a n d/ or
T w a v e i n v er si o n)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
E K G m o d ül ü ( E C G m o d ul e) 2
St u d y I D #
__________________________________
Y o u ar e vi e wi n g E C G s fr o m t h e p ati e nt wit h t h e r e c or d n u m b er of [r e c or d_i d], w h o i s a [ a g e] y e ar- ol d [ g e n d er]. T hi s
p ati e nt w a s a d mitt e d t o [ m er k e z] o n [r a n d o mi z a s y o n_t ari hi].
T o a c c e s s P M C ar di o A p p: htt p s:// dif o c c ult. p m c ar di o. c o m
T h e fir st pr e- P CI E C G
 [ e k g 1:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e s e c o n d pr e- P CI E C G
 [ e k g 2:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e t hir d pr e- P CI E C G
 [ e k g 3:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e f o urt h pr e- P CI E C G
 [ e k g 4:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
T h e fift h pr e- P CI E C G
 [ e k g 5:i nli n e]  
E x p ert i nt er pr et ati o n:
O MI 
n ot- O MI 
U n d efi n e d
Ar e t h er e a n y d y n a mi c c h a n g e s s u g g e sti v e of O MI i n
Y e s
pr e- P CI E C G s  ?
N o
U n d efi n e d
( D y n a mi c S T- T c h a n g e s, Q w a v e d e v el o p m e nt)
T h e fir st p o st- P CI E C G
 [ p o st p ci_ e k g:i nli n e]
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
P a g e 2
P o st- P CI 2 4 h E C G
 [ p o st e k g 2 4:i nli n e]
P o st- P CI 4 8 h E C G
 [ p o st e k g 4 8:i nli n e]
P o st- P CI 7 2 h E C G
 [ p o st e k g 7 2:i nli n e]
D o e s E C G s h o w e v ol uti o n c o m p ati bl e wit h a c ut e
Y e s
m y o c ar di al i nf ar cti o n  ?
N o
U n d efi n e d
( C h ar a ct eri sti c Q w a v e a n d/ or S T n or m ali z ati o n a n d/ or
T w a v e i n v er si o n)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
A nji y o gr afi ( A n gi o gr a p h y)
St u d y I D #
__________________________________
Di d t h e p ati e nt u n d er g o a n gi o gr a p h y ?
E v et 
H a yır
D at e of a n gi o gr a m
( A s d a y- m o nt h- y e ar a n d h o ur: mi n ut e)
__________________________________
A c c e s s sit e
( V a s c ul ar a c c e s s sit e f or pri m ar y P CI)
R a di al 
F e m or al
A n gi n a r eli e v e d b ef or e a n gi o gr a p h y ?
Y e s 
N o 
U n k n o w n
S T- s e g m e nt el e v ati o n o n m o nit or r eli e v e d b ef or e
a n gi o gr a p h y ?
Y e s 
N o 
U n k n o w n
I nf ar ct-r el at e d art er y
N o n e
L M C A
L A D
C X
R C A
Ot h er or m or e t h a n o n e
E nt er t h e " ot h er" art er y
(I M, i nt er m e di ar y art er y; D, di a g o n al art er y; O M,
__________________________________
o bt u s e m ar gi n al art er y et c.)
C ul prit l o o ki n g l e si o n
T ot al o c cl u si o n wit h a n i m pr e s si o n of b ei n g a c ut e
( S el e ct all t h at a p pli e s)
> 9 0 % di a m et er st e n o si s
Pr e s e n c e of t hr o m b u s
C o ntr a st st ai ni n g
Irr e g ul ar b or d er s s u g g e sti n g ul c er at e d pl a q u e
TI MI fl o w l e v el b ef or e P CI t o c ul prit l e si o n
TI MI 0, N o p erf u si o n
TI MI 1, N o p erf u si o n b ut p e n etr ati o n ( c o ntr a st
p e n etr at e s p a st t h e l e si o n, b ut c a n n ot r e a c h
di st al c or o n ar y b e d)
TI MI 2, P arti al p erf u si o n ( c o ntr a st r e a c h e s t o
di st al v a s c ul ar b e d, b ut e ntr y, filli n g a n d
cl e ar a n c e ar e sl o w er t h a n ot h er v e s s el s)
TI MI 3, C o m pl et e p erf u si o n ( di st al fl o w a n d
cl e ar a n c e ar e t h e s a m e a s t h o s e i n ot h er v e s s el s)
P CI t o c ul prit l e si o n ?
E v et 
H a yır
TI MI fl o w l e v el aft er P CI t o c ul prit l e si o n
TI MI 0, N o p erf u si o n
TI MI 1, N o p erf u si o n b ut p e n etr ati o n ( c o ntr a st
p e n etr at e s p a st t h e l e si o n, b ut c a n n ot r e a c h
di st al c or o n ar y b e d)
TI MI 2, P arti al p erf u si o n ( c o ntr a st r e a c h e s t o
di st al v a s c ul ar b e d, b ut e ntr y, filli n g a n d
cl e ar a n c e ar e sl o w er t h a n ot h er v e s s el s)
TI MI 3, C o m pl et e p erf u si o n ( di st al fl o w a n d
cl e ar a n c e ar e t h e s a m e a s t h o s e i n ot h er v e s s el s)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
P a g e 2
A d diti o n al l e si o n s
L M C A
( S el e ct f or di a m et er st e n o si s of > 3 0 % f or L M C A a n d 5 0 %
L A D
f or ot h er v e s s el s. D o n ot i n cl u d e c hr o ni c t ot al
C X
o c cl u si o n.)
R C A
Ot h er l e si o n s
N o n e
E nt er ot h er a d diti o n al l e si o n s
(I M, i nt er m e di ar y art er y; D, di a g o n al art er y; O M,
__________________________________
o bt u s e m ar gi n al art er y et c. M ulti pl e l e si o n s s h o ul d b e
s e p ar at e d wit h c o m m a s)
V e s s el s wit h c hr o ni c t ot al o c cl u si o n s
L M C A
( D o n ot i n cl u d e i nf ar ct-r el at e d art er y.)
L A D
C X
R C A
Ot h er a d diti o n al l e si o n s
E nt er ot h er c hr o ni c t ot al o c cl u si o n s
(I M, i nt er m e di ar y art er y; D, di a g o n al art er y; O M,
__________________________________
o bt u s e m ar gi n al art er y et c.)
A n y a d diti o n al P CI ?
( T h e n u m b er v e s s el s wit h n o n- c ul prit P CI at t h e s a m e
a d mi s si o n)
0 
1 
2 
≥3
Si n c e t h e p ati e nt i s e x cl u d e d, y o u d o n ot n e e d t o fill t hi s f or m. 
(If y o u t hi n k t hi s i s a n err or, pl e a s e c h e c k y o ur a n s w er f or " H a s t h e p ati e nt b e e n e x cl u d e d ?" o n t h e fir st f or m
(I d e ntifi c ati o n).)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
H a st a n e d e ki kli ni k d e ği ş k e nl er (I n- h o s pit al cli ni c al
p ar a m et er s)
St u d y I D #
__________________________________
U pl o a d p o st- P CI E C G
(if P CI n ot d o n e, t h e fir st E C G at C C U)
U pl o a d 2 4t h h o ur E C G
U pl o a d 4 8t h h o ur E C G
U pl o a d 7 2 n d h o ur E C G
2 4 h tr o p o ni n l e v el
(tr o p o ni n l e v el i n n g/ L [ = p g/ m L], e. g.; 1 2)
__________________________________
4 8 h tr o p o ni n l e v el
(tr o p o ni n l e v el i n n g/ L [ = p g/ m L], e. g.; 1 2)
__________________________________
7 2 h tr o p o ni n l e v el
(tr o p o ni n l e v el i n n g/ L [ = p g/ m L], e. g.; 1 2)
__________________________________
Ej e cti o n fr a cti o n
( P er c e nt a g e, e. g.; 5 5)
__________________________________
W all m oti o n s c or e 
( T ot al p oi nt i n 1 7- s e g m e nt m o d el, w h er e
__________________________________
1 = n or m o k y n e si a, 2 = h y p o k y n e si a, 3 = a k y n e si a)
A n y ot h er o c cl u si o n or r e- o c cl u si o n d uri n g h o s pit al
E v et
st a y ?
H a yır
Si n c e t h e p ati e nt i s e x cl u d e d, y o u d o n ot n e e d t o fill t hi s f or m. 
(If y o u t hi n k t hi s i s a n err or, pl e a s e c h e c k y o ur a n s w er f or " H a s t h e p ati e nt b e e n e x cl u d e d ?" o n t h e fir st f or m
(I d e ntifi c ati o n).)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
DI F O C C U L T 3
P a g e 1
Çı kı ş bil gil eri ( Cli ni c al p ar a m et er s o n di s c h ar g e)
St u d y I D #
__________________________________
R e c o m m e n d all o wi n g a c c e s s f or p h y si ci a n s t o e- p ul s e a c c o u nt.
( F or e a s y a c c e s s t o l o n g-t er m f oll o w- u p).
I n- h o s pit al i nt u b ati o n aft er r a n d o mi z ati o n
E v et 
H a yır
I n- h o s pit al c ar di o p ul m o n ar y r e s u s cit ati o n aft er
r a n d o mi z ati o n
E v et 
H a yır
I n- h o s pit al m ort alit y aft er r a n d o mi z ati o n
E v et 
H a yır
Fi n al di a g n o si s
M y o c ar di al i nf ar cti o n
Ot h er tr o p o ni n el e v ati o n s ( H e art f ail ur e,
(If pr eli mi n ar y di a g n o si s i s c o nfir m e d, s el e ct
m y o c ar diti s, p ul m o n ar y e m b oli s m et c.)
" M y o c ar di al i nf ar cti o n". If t h e p ati e nt w a s e nr oll e d
Ot h er
wit h a pr eli mi n ar y di a g n o si s of MI, b ut  m y o c ar di al
i nj ur y h a s b e e n a c c o u nt e d f or a n ot h er r e a s o n l at er o n,
t h e n s el e ct " Ot h er tr o p o ni n el e v ati o n s". If n o
tr o p o ni n ri s e o b s er v e d, s el e ct " Ot h er". If t h e p ati e nt
di e d b ef or e a n y tr o p o ni n r e s ult c o ul d b e o bt ai n e d,
d e ci d e a c c or di n g t o cli ni c al s c e n ari o). 
A s piri n
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
P 2 Y 1 2 i n hi bit or s
N o n e
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
Cl o pi d o gr el
Ti c a gr el or
Pr a s u gr el
O A C/ N O A C
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
A C Ei/ A R B
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
A R NI
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
S G L T 2i
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
B et a- bl o c k er
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
C al ci u m c h a n n el bl o c k er
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
M R A
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

pr oj e ctr e d c a p. or g
P a g e 2
L o o p di ur eti c
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
St ati n
( Pr e s cri b e d m e di c ati o n s o n di s c h ar g e)
E v et 
H a yır
Si n c e t h e p ati e nt i s e x cl u d e d, y o u d o n ot n e e d t o fill t hi s f or m. 
(If y o u t hi n k t hi s i s a n err or, pl e a s e c h e c k y o ur a n s w er f or " H a s t h e p ati e nt b e e n e x cl u d e d ?" o n t h e fir st f or m
(I d e ntifi c ati o n) or "I n- h o s pit al m ort alit y ?" i n Di s c h ar g e d at a f or m.)
DI F O C C U L T- 3 Tri al 
C o nfi d e nti al 
D o n ot di stri b ut e

projectredcap.org
DIFOCCULT 3
Page 1
Takip ve sonlanım (Long-term follow-up)
Study ID#
__________________________________
Long-term hospitalization
(Hospitalization in the first year)
Evet
Hayır
Date of hospitalization
(The first hospitalization after discharge)
__________________________________
Was the reason for hospitalization cardiovascular in
origin ?
Yes
No
Unknown
Due to coronary by-pass surgery ?
(Direct transfer after index admission or planned
surgery after discharge)
Evet
Hayır
Was the cause of admission PCI ?
(Can be an elective or emergent admission.)
Evet
Hayır
Was this PCI planned  ?
(Can be an elective or emergent PCI.)
Evet
Hayır
Long-term mortality
(Mortality in the first year after discharge)
Evet
Hayır
Mortality date
__________________________________
Was the reason for death cardiovascular in origin ?
Yes
No
Unknown
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DIFOCCULT-3 Trial 
Condifential 
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