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UA/NSTEMI (ACC)

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Table 7. Short-Term Risk of Death or Nonfatal MI in Patients With UA/NSTEMIa Low Risk Intermediate Risk High Risk Feature History No high-risk feature, but must have 1 of the following: Accelerating tempo of ischemic symptoms in preceding 48 h No high- or intermediate-risk feature but may have any of the following features: •  Prior MI, peripheral or cerebrovascular disease, or CABG •  Prior ASA use At least 1 of the following features must be present: Character Prolonged ongoing   of pain (>20 min) rest pain •  Prolonged (>20 min) •  Increased rest angina, now angina resolved, with moderate frequency, or high likelihood of severity, or CAD duration •  Rest angina (>20 min) •  Angina or relieved with rest or provoked at a sublingual NTG lower threshold •  Nocturnal angina •  New-onset •  New-onset or angina with progressive CCS class onset 2-8 wk   III or IV angina in prior to the past 2 wk without presentation prolonged (>20 min) rest pain but with intermediate or high likelihood of CAD Clinical findings •  Pulmonary edema, most likely due to ischemia •  New or worsening MR murmur •  S3 or new/worsening rales •  Hypotension, bradycardia, tachycardia •  Age >75 y ECG •  Angina at rest with transient ST-segment changes >0.5 mm •  Bundle-branch block, new or presumed new •  Sustained ventricular tachycardia •  T-wave changes Normal or •  Pathological Q waves or unchanged ECG resting ST-depression <1 mm in multiple lead groups (anterior, inferior, lateral) Cardiac markers Elevated cardiac TnT, TnI, or CK-MB (eg, TnT or TnI >0.1 ng/mL) Slightly elevated cardiac TnT, TnI, or CK-MB   (eg, TnT >0.01 but   <0.1 ng/mL) a Age >70 y Normal Estimation of the short-term risks of death and nonfatal cardiac ischemic events in UA (or NSTEMI) is a complex multivariable problem that cannot be fully specified in a table such as this. Therefore, this table is meant to offer general guidance and illustration rather than rigid algorithms. Adapted from AHCPR Clinical Practice Guidelines No. 10, Unstable Angina: Diagnosis and Management, May 1994. 29

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