Treatment
ÎÎRisk-stratification models, such as the Thrombolysis In Myocardial
Infarction (TIMI) (http://www.mdcalc.com/timi-risk-score-foruanstemi/) or Global Registry of Acute Coronary Events (GRACE)
risk score (http://www.outcomes-umassmed.org/grace/acs_risk/
acs_risk_content.html) or the Platelet Glycoprotein IIb/IIIa in Unstable
Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) risk
model (http://circ.ahajournals.org/content/101/22/2557.long), can
be useful to assist in decision making with regard to treatment options
in patients with suspected ACS. (IIa-B)
ÎÎIt is reasonable to remeasure positive biomarkers at 6- to 8-h intervals
2-3 times or until levels have peaked as an index of infarct size and the
dynamics of necrosis. (IIa-B)
ÎÎIt is reasonable to obtain supplemental ECG leads V7 through V9 in
patients whose initial ECG is nondiagnostic to rule out MI due to left
circumflex occlusion. (IIa-B)
ÎÎContinuous 12-lead ECG monitoring is a reasonable alternative
to serial 12-lead recordings in patients whose initial ECG is
nondiagnostic. (IIa-B)
ÎÎFor patients who present within 6 h of the onset of symptoms
consistent with ACS, assessment of an early marker of cardiac injury
(eg, myoglobin) in conjunction with a late marker (eg, troponin) may be
considered. (IIb-B)
ÎÎFor patients who present within 6 h of symptoms suggestive of ACS, a
2-h delta-CK-MB mass in conjunction with 2-h delta-troponin may be
considered. (IIb-B)
ÎÎFor patients who present within 6 h of symptoms suggestive of
ACS, myoglobin in conjunction with CK-MB mass or troponin when
measured at baseline and 90 min may be considered. (IIb-B)
ÎÎMeasurement of B-type natriuretic peptide (BNP) or NT-pro-BNP may
be considered to supplement assessment of global risk in patients
with suspected ACS. (IIb-B)
ÎÎTotal CK (without MB), aspartate aminotransferase (AST, SGOT),
alanine transaminase (ALT), beta-hydroxybutyric dehydrogenase, and/
or lactate dehydrogenase (LDH) should NOT be utilized as primary
tests for the detection of myocardial injury in patients with chest
discomfort suggestive of ACS. (III-C)
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