Version June 2024
| 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 |
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