Table 1

Patients With Acute Coronary Syndromes

IndicationAppropriate Use Score (1–9)
1.
  • STEMI

  • Less than or equal to 12 hours from onset of symptoms

  • Revascularization of the culprit artery

A (9)
2.
  • STEMI

  • Onset of symptoms within the prior 12 to 24 hours

  • Severe HF, persistent ischemic symptoms, or hemodynamic or electrical instability present

A (9)
3.
  • STEMI

  • Greater than 12 hours from symptom onset

  • Asymptomatic; no hemodynamic instability and no electrical instability

I (3)
4.
  • STEMI with presumed successful treatment with fibrinolysis

  • Evidence of HF, recurrent ischemia, or unstable ventricular arrhythmias present

  • One-vessel CAD presumed to be the culprit artery

A (9)
5.
  • STEMI with presumed successful treatment with fibrinolysis

  • Asymptomatic; no HF or no recurrent ischemic symptoms, or no unstable ventricular arrhythmias

  • Normal LVEF

  • One-vessel CAD presumed to be the culprit artery

U (5)
6.
  • STEMI with presumed successful treatment with fibrinolysis

  • Asymptomatic; no HF, no recurrent ischemic symptoms, or no unstable ventricular arrhythmias at time of presentation

  • Depressed LVEF

  • Three-vessel CAD

  • Elective/semielective revascularization

A (8)
7.
  • STEMI with successful treatment of the culprit artery by primary PCI or fibrinolysis

  • Asymptomatic; no HF, no evidence of recurrent or provokable ischemia, or no unstable ventricular arrhythmias during index hospitalization

  • Normal LVEF

  • Revascularization of a non-infarct-related artery during index hospitalization

I (2)
8.
  • STEMI or NSTEMI and successful PCI of culprit artery during index hospitalization

  • Symptoms of recurrent myocardial ischemia and/or high-risk findings on noninvasive stress testing performed after index hospitalization

  • Revascularization of ≥1 additional coronary arteries

A (8)
←9.
  • UA/NSTEMI and low-risk features (e.g., TIMI score ≤2) for short-term risk of death or nonfatal MI

  • Revascularization of the presumed culprit artery

U (6)
10.
  • UA/NSTEMI and intermediate-risk features (e.g., TIMI score 3–4) for short-term risk of death or nonfatal MI

  • Revascularization of the presumed culprit artery

A (8)
11.
  • UA/NSTEMI and high-risk features for short-term risk of death or nonfatal MI

  • Revascularization of the presumed culprit artery

A (9)
12.
  • UA/NSTEMI and high-risk features for short-term risk of death or nonfatal MI

  • Revascularization of multiple coronary arteries when the culprit artery cannot clearly be determined

A (9)
13.
  • Patients with acute myocardial infarction (STEMI or NSTEMI)

  • Evidence of cardiogenic shock

  • Revascularization of ≥1 coronary arteries

A (8)

New and updated indications are shaded blue.

A = appropriate; CAD = coronary artery disease; HF = heart failure; I = inappropriate; LVEF = left ventricular ejection fraction; MI = myocardial infarction; NSTEMI = non–ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention; STEMI =ST-segment elevation myocardial infarction; TIMI = Thrombolysis In Myocardial Infarction; U = uncertain; UA = unstable angina.