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Person—acute coronary syndrome risk stratum, code N

Identifying and definitional attributes

Metadata item type:Help on this termData Element
Short name:Help on this termAcute coronary syndrome stratum
METeOR identifier:Help on this term284656
Registration status:Help on this termHealth, Superseded 01/10/2008
Definition:Help on this termRisk stratum of the patient presenting with clinical features consistent with an acute coronary syndrome defined by accompanying clinical, electrocardiogram (ECG) and biochemical features, as represented by a code.
Data Element Concept:Person—acute coronary syndrome risk stratum

Value domain attributes

Representational attributes

Representation class:Help on this termCode
Data type:Help on this termNumber
Format:Help on this termN
Maximum character length:Help on this term1
Permissible values:Help on this term
ValueMeaning
1with ST elevation (myocardial infarction)
2with non-ST elevation ACS with high-risk features
3with non-ST elevation ACS with intermediate-risk features
4with non-ST elevation ACS with low-risk features
Supplementary values:Help on this term
9Not reported

Collection and usage attributes

Guide for use:Help on this term

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.

Source and reference attributes

Submitting organisation:Help on this termAustralian Institute of Health and Welfare

Data element attributes

Collection and usage attributes

Guide for use:Help on this termOther clinical considerations influencing the decision to admit and investigate are not reflected in this metadata item. This metadata item is intended to simply provide a diagnostic classification at the time of, or within hours of clinical presentation.
Collection methods:Help on this term

Collected at time of presentation.

Only one code should be recorded.

Must be collected in conjunction with Person—acute coronary syndrome procedure type, code NN and Person—clinical procedure timing, code N.

Source and reference attributes

Submitting organisation:Help on this termAcute coronary syndrome data working group
Steward:Help on this termThe National Heart Foundation of Australia and The Cardiac Society of Australia and New Zealand
Origin:Help on this termManagement of Unstable Angina Guidelines - 2000, The National Heart Foundation of Australia, The Cardiac Society of Australia and New Zealand MJA, 173 (Supplement) S65-S88 Antman, MD; et al.
The TIMI Risk Score for Unstable Angina/Non-ST Elevation MI JAMA. 2000; 284:835-842.

Relational attributes

Related metadata references:Help on this term

Supersedes Acute coronary syndrome stratum, version 1, DE, NHDD, NHIMG, Superseded 01/03/2005.pdf (20.6 KB)

Has been superseded by Person—acute coronary syndrome risk stratum, code N Health, Standard 01/10/2008

See also Person—acute coronary syndrome symptoms onset date, DDMMYYYY Health, Standard 01/10/2008

Implementation in Data Set Specifications:Help on this term

Acute coronary syndrome (clinical) DSS Health, Superseded 01/10/2008

Acute coronary syndrome (clinical) DSS Health, Superseded 07/12/2005

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