Version May 2024
| High risk (at least one of the following features must be present): |
| History: |
| Accelerating tempo of ischemic symptoms in preceding 48 hours |
| Character of pain: |
| Prolonged ongoing (>20 min) rest pain |
| Clinical findings: |
| Pulmonary edema, most likely due to ischemia |
| New or worsening MR murmur |
| S3 or new/worsening rales |
| Hypotension, bradycardia, tachycardia |
| Age >75 years |
| ECG: |
| Angina at rest with transient ST-segment changes >0.5 mm |
| Bundle-branch block, new or presumed new |
| Sustained ventricular tachycardia |
| Cardiac markers: |
| Elevated cardiac TnT, TnI, or CK-MB (eg, TnT or TnI >0.1 ng per mL) |
| Intermediate risk (no high-risk feature but must have one of the following): |
| History: |
| Prior MI, peripheral or cerebrovascular disease, or CABG; prior aspirin use |
| Character of pain: |
| Prolonged (>20 min) rest angina, now resolved, with moderate or high likelihood of CAD |
| Rest angina (>20 min) or relieved with rest or sublingual NTG |
| Nocturnal angina |
| New onset or progressive CCS class III or IV angina in the past two weeks without prolonged (>20 min) rest pain but with intermediate or high likelihood of CAD |
| Clinical findings: |
| Age >70 years |
| ECG: |
| T-wave changes |
| Pathological Q waves or resting ST-depression less than 1 mm in multiple lead groups (anterior, inferior, lateral) |
| Cardiac markers: |
| Slightly elevated cardiac TnT, TnI, or CK-MB (eg, TnT greater than 0.01 but less than 0.1 ng per mL) |
| Low risk (no high- or intermediate-risk features, but may have any of the following features): |
| Character of pain: |
| Increased angina frequency, severity, or duration |
| Angina provoked at a lower threshold |
| New onset angina with onset two weeks to two months prior to presentation |
| ECG: |
| Normal or unchanged ECG |
| Cardiac markers: |
| Normal |
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