Likelihood That Signs and Symptoms Represent ACS Secondary to CAD

Feature High Likelihood Any of the following: Intermediate Likelihood Absence of high-likelihood features and presence of any of the following: Low Likelihood Absence of high- or intermediate-likelihood features but may have the following:
History Chest or left arm pain or discomfort as chief symptom reproducing prior documented angina; known history of CAD including
Chest or left arm pain or discomfort as chief symptom; age >70 years; male sex; diabetes mellitus Probable ischemic symptoms in absence of any intermediate-likelihood characteristics; recent cocaine use
Examination Transient MR murmur, hypotension, diaphoresis, pulmonary edema, or rales Extracardiac vascular disease Chest discomfort reproduced by palpation
ECG New or presumably new transient ST-segment deviation (≥1 mm) or T-wave inversion in multiple precordial leads Fixed Q waves ST depression 0.5 to 1 mm or T-wave inversion >1 mm T-wave flattening or inversion <1 mm in leads with dominant R waves Normal ECG
Cardiac markers Elevated cardiac TnI, TnT, or CK-MB Normal Normal
  • CAD indicates coronary artery disease; CK-MB, MB fraction of creatine kinase; ECG, electrocardiogram; MI, myocardial infarction;
    MR, mitral regurgitation; TnI, troponin I; and TnT, troponin T.

    Modified from Braunwald E, et al. Unstable Angina: Diagnosis and Management. 1994;3-1-AHCPR Publication No 94-0602:1-154. In the public domain.1


  1. Mehl LE. Electrical injury from Tasering and miscarriage. Acta Obstet Gynecol Scand. 1992;71:118–123.