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CHART 409

Short-Term Risk of Death or Nonfatal MI in Patients With UA/NSTEMI*


Low Risk (No High or Intermediate risk features but may have any of the following) Intermediate Risk (No High risk features, must have 1 of the following) Prior diagnosis of arterio-occlusive disease such as MI, PVD, CVD, or CABG; prior aspirin use Increased frequency, severity, or duration of angina Angina provoked at a lower threshold New onset angina with onset 2 weeks to 2 months prior to presentation Prolonged (> 20 minutes) rest angina, resolved at presentation, with likelihood of CAD Prolonged (> 20 minutes) angina relieved with rest or sublingual NTG Nocturnal angina New onset or progressive limitation of activity (walking 12 blocks, climbing 12 flights of stairs, pain with any physical exertion, angina at rest) in past 2 weeks without prolonged (> 20 minutes) rest pain but with likelihood of CAD. Age > 70 years High Risk (At least 1 of the following features must be present) Accelerating tempo (increased frequency, severity, or duration) of ischemic symptoms over last 48 hours Prolonged (> 20 minutes) ongoing at rest

Feature History

Pain Characteristics

Clinical Findings

Presence of any one of the following: pulmonary edema likely due to ischemia; new or worsening mitral regurgitation; S3 or new/worsening rales; hypotension, bradycardia, tachycardia Age > 75 years Angina at rest with transient ST-segment changes > 0.5 mm BBB new or presumed new Sustained VT Elevated cardiac TnT, TnI, or CK-MB

ECG

Normal or unchanged ECG

T wave changes Pathologic Qs or resting ST-segment depression > 1 mm in multiple lead groups (anterior, inferior, lateral) Slightly elevated TnT, TnI, or CK-MB

Cardiac Markers

Normal

Note: BBB-bundle branch block; CABG-coronary artery bypass graft surgery; CAD-coronary artery disease; CK-MB-creatine kinase, MB fraction; CVD-cerebral vascular disease; ECGelectrocardiogram; MI-myocardial infarction; NTG- nitroglycerin; PVD-peripheral vascular disease; TnI-troponin I; TnT- troponin T; UA/NSTEMI-unstable angina/nonST-elevation myocardial infarction; VT-ventricular tachycardia.
*Estimation of risk for adverse events should be done with patients who present with a history and/or signs and symptoms of cardiac ischemia and considered in patient treatment. from Table 7 page e17 of Anderson et. al, ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Content is meant to illustrate general guidelines and should not be used as practice algorithms.
Adapted