Table 4

Summary of Recommendations for Prognosis: Early Risk Stratification

RecommendationsCORLOEReferences
Perform rapid determination of likelihood of ACS, including a 12-lead ECG within 10 min of arrival at an emergency facility, in patients whose symptoms suggest ACSIC(21)
Perform serial ECGs at 15- to 30-min intervals during the first hour in symptomatic patients with initial nondiagnostic ECGICN/A
Measure cardiac troponin (cTnI or cTnT) in all patients with symptoms consistent with ACSIA(21,64,67–71)
Measure serial cardiac troponin I or T at presentation and 3–6 h after symptom onset in all patients with symptoms consistent with ACSIA(21,72–74)
Use risk scores to assess prognosis in patients with NSTE-ACSIA(42–44,75–80)
Risk-stratification models can be useful in managementIIaB(42–44,75–81)
Obtain supplemental electrocardiographic leads V7 to V9 in patients with initial nondiagnostic ECG at intermediate/high risk for ACSIIaB(82–84)
Continuous monitoring with 12-lead ECG may be a reasonable alternative with initial nondiagnostic ECG in patients at intermediate/high risk for ACSIIbB(85,86)
BNP or NT–pro-BNP may be considered to assess risk in patients with suspected ACSIIbB(87–91)

ACS indicates acute coronary syndromes; BNP, B-type natriuretic peptide; COR, Class of Recommendation; cTnI, cardiac troponin I; cTnT, cardiac troponin T; ECG, electrocardiogram; LOE, Level of Evidence; N/A, not available; NSTE-ACS, non−ST-elevation acute coronary syndromes; and NT–pro-BNP, N-terminal pro–B-type natriuretic peptide.

  • See Section 3.4, Class I, #3 recommendation if time of symptom onset is unclear.