Updating an institutional chest pain algorithm Adult local chats

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A rise in cardiac biomarkers (preferably cardiac troponin) with at least 1 value above the 99th percentile of the upper reference limit and/or a fall in cardiac biomarkers, together with at least 1 of the following: This quality statement is taken from the acute coronary syndromes (including myocardial infarction) quality standard.

Adults with non-ST-segment-elevation myocardial infarction (NSTEMI) or unstable angina are assessed for their risk of future adverse cardiovascular events using an established risk scoring system that predicts 6-month mortality to guide clinical management.

Cangrelor for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti-platelet therapy (terminated appraisal) (2015) NICE technology appraisal 351Myocardial infarction (acute): Early rule out using high-sensitivity troponin tests (Elecsys Troponin T high-sensitive, ARCHITECT STAT High Sensitive Troponin-I and Accu Tn I 3 assays) (2014) NICE diagnostics guidance 15 New generation cardiac CT scanners (Aquilion ONE, Brilliance i CT, Discovery CT750 HD and Somatom Definition Flash) for cardiac imaging in people with suspected or known coronary artery disease in whom imaging is difficult with earlier generation CT scanners (2012) NICE diagnostics guidance 3 These quality statements are taken from the acute coronary syndromes in adults quality standard.

The quality standard defines clinical best practice for acute coronary syndromes (including myocardial infarction) and should be read in full.Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution.They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available.

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