Assessment
Figure 1. Evaluation and Management of Patients Suspected
of Having ACS
Symptoms Suggestive of ACS
Noncardiac
Diagnosis
Treatment as
indicated by
alternative
diagnosis
Chronic Stable
Angina
Possible ACS
Definite ACS
No ST-Elevation
ACC/AHA
Chronic Stable
AnginaGuidelinesa
• Nondiagnostic
ECG
Normal initial
serum cardiac
biomarkers
• ST and/or
T-wave changes
• Ongoing pain
• Positive cardiac
biomarkers
• Hemodynamic
abnormalities
Observe
≥12 h from symptom onset
No recurrent pain;
negative follow-up
studies
ST-Elevation
Evaluate for
reperfusion therapy
• Recurrent ischemic pain or
positive follow-up studies
• Diagnosis of ACS confirmed
ACC/AHA
STEMI
Guidelinesb
• Stress study to provoke ischemia
• Consider evaluation of LV
function if ischemia is present
(tests may be performed
either prior to discharge or as
outpatient)
Negative
Potential diagnoses:
nonischemic
discomfort; low-risk
ACS
Positive
Diagnosis of ACS
confirmed or highly
likely
• Admit to hospital
• Manage via acute
ischemia pathway
Arrangements for
outpatient follow-up
Anderson JL et al. J Am Coll Cardiol. 2007;50:e1-e157.
a
See Revised 2012 Stable Ischemic Heart Disease Guideline.
b
See Revised 2013 ST-Elevation Myocardial Infarction Guideline
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