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4.1 Patients With Acute Chest Pain and Suspected ACS
(Not Including STEMI)
COR LOE
Recommendations
1 B-NR 1. In patients presenting with acute chest pain and suspected ACS,
clinical decision pathways (CDPs) should categorize patients
into low-, intermediate-, and high-risk strata to facilitate
disposition and subsequent diagnostic evaluation.
1 B-NR 2. In the evaluation of patients presenting with acute chest pain
and suspected ACS for whom serial troponins are indicated to
exclude myocardial injury, recommended time intervals after
the initial troponin sample collection (time zero) for repeat
measurements are: 1 to 3 hours for high-sensitivity troponin
and 3 to 6 hours for conventional troponin assays.
1 C-LD 3. To standardize the detection and differentiation of myocardial
injury in patients presenting with acute chest pain and
suspected ACS, institutions should implement a CDP that
includes a protocol for troponin sampling based on their
particular assay
1 C-LD 4. In patients with acute chest pain and suspected ACS, previous
testing when available should be considered and incorporated
into CDPs.
2a B-NR 5. For patients with acute chest pain, a normal ECG, and
symptoms suggestive of ACS that began at least 3 hours
before ED arrival, a single hs-cTn concentration that is below
the limit of detection on initial measurement (time zero) is
reasonable to exclude myocardial injury.
