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● By default patients with chest pain of >20 min duration are considered as suffering from an Acute Coronary Syndrome until this syndrome has been excluded.
● A minority of such patients will immediately display an ST elevation in ECG, which is pathognomonic for transmural myocardial infarctions (STEMI).
● Patients with no ST elevation should be monitored over several hours for changes in the concentration of troponin, which is released from an ischaemic myocardium. You diagnose NSTEMI if troponin is elevated in the absence of ST elevation.
● The remaining patients (those with neither ST elevation nor troponin accumulation) are classified as having an Unstable Angina Pectoris. Once the symptoms have subsided, these patients are usually discharged but make sure that they are prescribed and take drugs against coronary artery disease, most importantly low-dose aspirin and a statin, and that they have at their disposal the symptom reliever glyceryl trinitrate.
● Scoring systems such as TIMI or GRACE can be used to determine the need and urgency for a diagnostic percutaneous intervention, which usually results in stent insertion. For a limited time period "stented" patients receive an ADP receptor blocker in addition to statin and low-dose aspirin.