MDCalc

ADAPT Protocol for Cardiac Event Risk

Assesses chest pain patients at 2 hours for risk of cardiac event.

Abnormal troponin at 0 or 2 hours
Ischemic changes on EKG

TIMI Risk Score for UA/NSTEMI
Note: The TIMI Risk Score for UA/NSTEMI includes cardiac enzymes and ST deviation which are listed above and therefore excluded from the TIMI inputs below.

Age ≥65 years
≥3 CAD risk factors
Hypertension, hypercholesterolemia, diabetes, family history of coronary artery disease, or current smoker
Known CAD (stenosis ≥50%)
Aspirin use in past 7 days
Severe angina (≥2 episodes in 24 hrs or persisting discomfort)

Result:

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Advice

Barring other concerning features for acute coronary syndrome or other life-threatening causes of chest pain (pneumothorax, pulmonary embolism, cardiac tamponade, aortic dissection, esophageal rupture, etc.), patients that meet the low-risk criteria can be considered for discharge with close follow-up with their primary care physician after negative 0h and 2h troponin testing.

Patients who do not meet the low-risk criteria should be ruled-out for myocardial infarction with serial EKGs and biomarkers and risk stratified as per normal chest pain guidelines and protocols.

Management
  • For low-risk patients: consider other causes of chest pain due to aortic, esophageal, pulmonary, cardiac, and abdominal, and musculoskeletal sources prior to discharge.
  • For non-low-risk patients: Treat as per usual chest pain protocols, including but not limited to consideration of aspirin, nitroglycerin, and serial EKGs and biomarkers at minimum.
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