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Risk Stratification of Non-ST Elevation ACS Patients in the ED

Risk Stratification of Non-ST Elevation ACS Patients in the ED - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Cardiovascular, Related


Risk Stratification for NSTE-ACS Patients in the Emergency Department
HIGH RISK INTERMEDIATE RISK LOW RISK
At least 1 of the following: No high-risk features, but 1 of the following: No high- or intermediate-risk features, but any
of the following:
History
Accelerating tempo of
ischemic symptoms in
preceding 48 hrs.
ξPrior MI, peripheral or cerebrovascular disease, or
CABG
ξPrior aspirin use
N/A
Characteristics of Pain Prolonged ongoing
(>20 min.) rest pain
ξProlonged (>20 min.) rest angina, now resolved, with
moderate to high likelihood of CAD
ξRest angina (>20 min.) or relieved with rest or
sublingual NTG
ξNocturnal angina
ξNew-onset or progressive CCS Class III or IV angina
in previous 2 wks. without prolonged (>20 min) rest
pain but with intermediate or high likelihood of CAD
ξIncreased angina frequency,
severity, or duration
ξAngina provoked at a lower
threshold
ξNew-onset angina with onset 2 wks.
to 2 months before presentation
Clinical Findings
ξPulmonary edema, most
likely due to ischemia
ξNew or worsening mitral
regurgitation murmur S3
or new/worsening rales
ξHypotension,
bradycardia, or
tachycardia
ξAge > 75 yrs.
Age > 70 yrs. N/A
ECG
ξAngina at rest with
transient ST-segment
changes > 0.5mm
ξBundle-branch block, new
or presumed new
ξSustained ventricular
tachycardia
ξT-wave changes
ξPathological Q waves or resting ST-depression <
1mm in multiple lead groups (anterior, inferior,
lateral)
Normal or unchanged ECG
Cardiac Markers
(UW Health Lab) TnI > 0.50 ng/mL TnI = 0.06-0.49 ng/mL TnI = 0.00-0.05 ng/mL
Last revised/reviewed: 04/2015 | Contact CCKM for revisions. | UW Health Non-ST-Elevation Acute Coronary Syndromes – Adult – Inpatient/Ambulatory CPG
Reference: Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the
American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive
Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354-471.
Copyright © 2015 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised: 04/2015CCKM@uwhealth.org