High risk |
Intermediate risk |
Low risk |
At least one of the following
features must be present |
No high-risk feature but must
have any of the following |
No high- or intermediate-risk
feature but may have any of the following |
History |
Accelerating tempo of ischemic symptoms in preceding 48
hours |
Prior MI, peripheral or cerebrovascular disease, CABG,
or prior aspirin use |
|
Character
of pain |
Prolonged (>20 min) and ongoing rest pain |
Prolonged rest angina (>20 min), now resolved,
with moderate or high likelihood of CAD |
Angina provoked at a low threshold, increased angina frequency, severity or duration. New onset angina with onset two weeks to two months prior to presentation. |
Rest angina (>20 min) or relieved with rest or
sublingual NTG |
Nocturnal angina |
New or progressive class III or IV angina in past two weeks without prolonged (>20 min) rest pain but with intermediate or high likelihood of CAD. |
Clinical
findings |
Pulmonary edema, most likely due to ischemia |
Age >70 years |
|
New or worsening mitral regurgitation murmur |
S3 or new or worsening rales |
Hypotension, bradycardia, tachycardia |
Age >75 years |
ECG |
Angina at rest with transient ST segment changes
>0.5 mV |
T-wave changes |
Normal or unchanged ECG |
New or presumed new bundle branch block |
Pathologic Q waves or resting ST depression less than 1 mm in multiple lead groups |
Sustained ventricular tachycardia |
|
Cardiac
markers |
Markedly elevated (eg, cTnT or cTnI >0.1 ng/mL) |
Slightly elevated (eg, cTnT >0.01 but
<0.1 ng/mL) |
Normal |