Acute coronary syndrome risk stratum code N

Guide for use:

CODE 1     With ST elevation (myocardial infarction)

This code is used where persistent ST elevation of >=1mm in two contiguous limb leads, or ST elevation of >=2mm in two contiguous chest leads, or with left bundle branch block (BBB) pattern on the ECG.

This classification is intended for identification of patients potentially eligible for reperfusion therapy, either pharmacologic or catheter-based. Other considerations such as the time to presentation and the clinical appropriateness of instituting reperfusion are not reflected in this metadata item.

CODE 2     With non-ST elevation ACS with high-risk features

This code is used when presentation with clinical features consistent with an acute coronary syndrome (chest pain or overwhelming SOB) with high-risk features which include either:

• classical rise and fall of at least one cardiac biomarker (troponin or CK-MB),
• persistent or dynamic ECG changes of ST segment depression >= 0.5mm or new T wave inversion in three or more contiguous leads,
• transient (< 20 minutes) ST segment elevation (>= 0.5 mm) in more than 2 contiguous leads,
• haemodynamic compromise: Blood pressure < 90 mmHg systolic, cool peripheries, diaphoresis, Killip Class > 1, and/or new onset mitral regurgitation, and/or syncope, or
• presence of known diabetes without persistent ST elevation of > 1mm in two or more contiguous leads or new or presumed new bundle branch block (BBB) pattern on the initial ECG, i.e. not meeting the definition for ST elevation MI.
  This classification is intended for identification of patients potentially eligible for early invasive management and the use of intravenous glycoprotein IIb/IIIa inhibition.

CODE 3     With non-ST elevation ACS with intermediate-risk features

This code is used when presentation with clinical features consistent with an acute coronary syndrome (chest pain or overwhelming SOB) with intermediate-risk features which include either:

• prolonged but resolved chest pain/discomfort at rest < 48 hours,
• age greater than 65yrs,
• known coronary heart disease: prior MI, prior revascularisation, known coronary lesion > 50%,
• pathological Q waves or ECG changes of ST deviation < 0.5mm or minor T wave inversion in less than 3 contiguous leads,
• nocturnal pain,
• two or more risk factors of known hypertension, family history, active smoking or hyperlipidaemia, or
• prior aspirin use and not meeting the definition for ST elevation MI or Non-ST elevation with high-risk features.

This classification is intended for identification of patients potentially eligible for admission and in-hospital investigation that may or may not include angiography.

CODE 4     With non-ST elevation ACS with low-risk features

This code is used when presentation with clinical features consistent with an acute coronary syndrome (chest pain or overwhelming SOB) without features of ST elevation MI or Non-ST elevation ACS with intermediate or high-risk features.

This classification is intended for identification of patients potentially eligible for outpatient investigation.