Non-ST Elevation Acute Coronary Syndromes (beta)
Official guideline from the American College of Emergency Physicians.
summary by Eric Steinberg, DO, and Hyunjoo Lee, MD
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.
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.