The Living Guidelines: UA/NSTEMI Recommendations for Early Risk Stratification Suggest Revisions to the CLASS IIa Guidelines

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Class IIa Guidelines

 * 1) Use of risk stratification models, such as the Thrombolysis In Myocardial Infarction (TIMI) or Global Registry of Acute Coronary Events (GRACE) risk score or the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) risk model, can be useful to assist in decision making with regard to treatment options in patients with suspected ACS. (Level of Evidence: B)
 * 2) It is reasonable to remeasure positive biomarkers at 6 to 8 hours intervals, 2 to 3 times or until levels have peaked, as an index of infarct size and dynamics of necrosis. (Level of Evidence: B)
 * 3) It is reasonable to obtain supplemental ECG leads V7 through V9 in patients whose initial ECG is non diagnostic to rule out MI due to left circumflex occlusion. (Level of Evidence: B)
 * 4) Continuous 12 lead ECG monitoring is a reasonable alternative to serial 12-lead recordings in patients whose initial ECG is non diagnostic. (Level of Evidence: B)