Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation

3. Patients with a suspected acute coronary syndrome should be observed, with repeat 12 lead ECG recording, during symptoms if the opportunity arises. Blood samples for cardiac troponin (troponin T or I) should be taken a minimum of 12 hours after the onset of symptoms. New ischaemic changes on the ECG or elevation of troponin confirm the diagnosis (see table 1 and recommendation 5). A 4. If at least 12 hours after the onset of symptoms of a suspected acute coronary syndrome: + the symptoms have not recurred; + the cardiac troponin is normal; + the ECG remains normal (or unchanged compared with a recording from before the current presentation); + and the cardiac enzymes are not raised; the patient can be mobilised and discharged. Risk assessment with stress testing should be performed unless contraindicated, preferably before discharge from hospital. ✓A