ACEP Non-ST Elevation Acute Coronary Syndrome Guidelines

We cover the clinical policy from the American College of Emergency Physicians - Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes In adult patients without evidence of ST-elevation acute coronary syndrome, can initial risk stratification be used to predict a low rate of 30-day major adverse cardiac events? Use HEART score ≤3  In adult patients with suspected acute non–ST-elevation acute coronary syndromes, can troponin testing within 3 hours of emergency department presentation be used to predict a low rate of 30-day major adverse cardiac events? Negative conventional troponins at 0,3 hrs in low risk patients High sensitivity troponin: undetectable initial troponin, no need for another. Negative initial troponin, repeat at 2 hours In adult patients with suspected acute non–ST-elevation acute coronary syndromes in whom acute myocardial infarction has been excluded, does further diagnostic testing (eg, provocative, stress test, computed tomography [CT] angiography) for acute coronary syndrome prior to discharge reduce 30-day major adverse cardiac events? No need to get provocative testing before discharge or within particular time frame Should adult patients with acute non–ST-elevation myocardial infarction receive immediate antiplatelet therapy in addition to aspirin to reduce 30-day major adverse cardiac events? antiplatelet therapy additional to aspirin can be given or delayed Thanks for listening! Jeremy Faust and Lauren Westafer