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.
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