Non-ST Elevation Acute Coronary Syndromes
Official guideline from the American College of Emergency Physicians.
summary by Eric Steinberg, DO, and Hyunjoo Lee, MD
Risk Stratification
In adult patients without evidence of ST-elevation acute coronary syndrome, the History, electrocardiogram [ECG], Age, Risk factors, Troponin (HEART) score can be used as a clinical prediction instrument for risk stratification. A low score (≤3) predicts a 30-day major adverse cardiac event miss rate within a range of 0% to 2%.
In adult patients without evidence of ST-elevation acute coronary syndrome, other risk-stratification tools, such as Thrombolysis in Myocardial Infarction (TIMI), can be used to predict a rate of 30-day major adverse cardiac event.
Diagnosis
In adult patients with suspected acute non–ST-elevation acute coronary syndrome who are determined to be low risk based on validated accelerated diagnostic pathways that include a nonischemic electrocardiogram (ECG) result and negative serial high-sensitivity troponin testing results both at presentation and at 2 hours can predict a low rate of 30-day major adverse cardiac events allowing for an accelerated discharge pathway from the emergency department.
Do not routinely use further diagnostic testing (coronary computed tomography [CT] angiography, stress testing, myocardial perfusion imaging) prior to discharge in low-risk patients in whom acute myocardial infarction has been ruled out to reduce 30-day major adverse cardiac events.