26
Treatment
Table 4. Warranty Period for Prior Cardiac Testing
Test Modality Result Warranty Period
Anatomic • Normal coronary
angiogram
• CCTA with no stenosis
or plaque
2 y
Stress testing • Normal stress test (given
adequate stress)
1 y
4.1.1. Low-Risk Patients With Acute Chest Pain
COR LOE
Recommendations
1 B-NR 1. Patients with acute chest pain and a 30-day risk of death or
MACE <1% should be designated as low risk.
2a B-R 2. In patients with acute chest pain and suspected ACS who are
deemed low-risk (<1% 30-day risk of death or MACE), it is
reasonable to discharge home without admission or urgent
cardiac testing.
Table 5. Definition Used for Low-Risk Patients With Chest
Pain
Low Risk (<1% 30-d Risk for Death or MACE)
hs-cTn Based
T-0 T-0 hs-cTn below the assay limit of detection or "very low"
threshold if symptoms present for at least 3 h
T-0 and 1- or 2-h Delta T-0 hs-cTn and 1- or 2-h delta are both below the assay
"low" thresholds (>99% NPV for 30-d MACE)
Clinical Decision Pathway Based
HEART Pathway HEART score <3, initial and serial cTn/hs-cTn < assay
99th percentile
EDACS EDACS <16; initial and serial cTn/hs-cTn < assay 99th
percentile
ADAPT TIMI score 0, initial and serial cTn/hs-cTn < assay 99th
percentile
mADAPT TIMI score 0/1, initial and serial cTn/hs-cTn < assay 99th
percentile
NOTR 0 factors
