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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 term356665
Registration status:Help on this termHealth, Standard 01/10/2008
Definition:Help on this termRisk stratum of a person 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
1ST-segment-elevation (myocardial infarction)
2Non-ST-segment-elevation ACS with high-risk features
3Non-ST-segment-elevation ACS with intermediate-risk features
4Non-ST-segment-elevation ACS with low-risk features
Supplementary values:Help on this term
9Not stated/inadequately described

Collection and usage attributes

Guide for use:Help on this term

CODE 1     ST-segment-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 new 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 intervention-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     Non-ST-segment-elevation ACS with high-risk features

This code is used when presentation with clinical features consistent with an acute coronary syndrome with high-risk features which include any of the following:

  • repetitive or prolonged (> 10 minutes) ongoing chest pain or discomfort;
  • elevated level of at least one cardiac biomarker (troponin or creatine kinase-MB isoenzyme);
  • persistent or dynamic ECG changes of ST segment depression >= 0.5mm or new T wave >= 2mm;
  • transient 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;
  • sustained ventricular tachycardia;
  • syncope;
  • left ventricular systolic dysfunction (left ventricular ejection fraction < 0.40);
  • prior percutaneous coronary intervention within 6 months or prior coronary artery bypass surgery;
  • presence of known diabetes (with typical symptoms of ACS);or
  • chronic kidney disease (estimated glomerular filtration rate < 60mL/minute) (with typical symptoms of ACS).

This classification is intended for identification of patients potentially eligible for aggressive medical management and coronary angiography and revascularisation.

CODE 3     Non-ST-segment-elevation ACS with intermediate-risk features

This code is used when presentation with clinical features consistent with an acute coronary syndrome and any of the following intermediate-risk features AND NOT meeting the criteria for high-risk ACS:

  • chest pain or discomfort within the past 48 hours that occurred at rest, or was repetitive or prolonged (but currently resolved);
  • age greater than 65yrs;
  • known coronary heart disease: prior myocardial infarction with left ventricular ejection fraction >= 0.40 known coronary lesion more than 50% stenosed;
  • no high-risk changes on electrocardiography (see high-risk features);
  • two or more of the following risk factors: known hypertension, family history, active smoking or hyperlipidaemia;
  • presence of known diabetes (with atypical symptoms of ACS);
  • chronic kidney disease (estimated glomerular filtration rate < 60mL/minute) (with atypical symptoms of ACS); or
  • prior aspirin use.

This classification is intended for identification of patients potentially eligible for accelerated diagnostic evaluation and further risk stratification.

CODE 4     Non-ST-segment-elevation ACS with low-risk features

This code is used when presentation with clinical features consistent with an acute coronary syndrome without intermediate or high-risk features of non-ST-segment-elevation ACS. This includes onset of anginal symptoms within the last month, or worsening in severity or frequency of angina, or lowering of anginal threshold.

This classification is intended for identification of patients potentially eligible for outpatient investigation discharge on upgraded medical therapy and outpatient investigation.

Data element attributes

Collection and usage attributes

Guide for use:Help on this term

Other 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.

Acute coronary syndrome symptoms may include:

  • tightness, pressure, heaviness, fullness or squeezing in the chest which may spread to the neck and throat, jaw, shoulders, the back, upper abdomen, either or both arms and even into the wrists and hands
  • dyspnoea, nausea/vomiting, cold sweat or syncope.
Collection methods:Help on this term

Recorded at time of presentation.

Only one code should be recorded.

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

Comments:Help on this termThe clinical, electrocardiogram and biochemical characteristics are important to enable early risk stratification.

Source and reference attributes

Submitting organisation:Help on this termAcute coronary syndrome data working group
Origin:Help on this term

National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184; S1-S32. © MJA 2006

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 Person—acute coronary syndrome risk stratum, code N Health, Superseded 01/10/2008

Implementation in Data Set Specifications:Help on this term

Acute coronary syndrome (clinical) DSS Health, Superseded 01/09/2012

Acute coronary syndrome (clinical) DSS Health, Superseded 02/05/2013

Acute coronary syndrome (clinical) NBPDS Health, Candidate 15/05/2017

Acute coronary syndrome (clinical) NBPDS 2013- Health, Standard 02/05/2013

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