CardiologyCriteria

ADAPT Protocol for Cardiac Event Risk

An Accelerated Diagnostic Protocol (ADAPT) that identifies chest pain patients at 2 hours who are at low risk of major adverse cardiac events (MACE), enabling safe early ED discharge.

Parameters

TIMI Risk Scoreany

Age ≥ 65 years (TIMI criterion)Known CAD (coronary stenosis ≥ 50%, prior MI, PCI, or CABG)ST deviation ≥ 0.5 mm on presenting ECG≥ 2 anginal events in past 24 hoursAspirin use in past 7 days (as a surrogate for chronic coronary artery disease)Elevated serum cardiac marker (troponin above the 99th percentile) at ANY measurement

ECG Findings (ANY present = Not low risk)any

New ischemic changes on ECG (ST depression ≥ 0.5 mm, ST elevation, or new LBBB)

Serial Troponin Results (ANY present = Not low risk)any

Initial troponin (0h) above institutional 99th percentile threshold2-hour troponin above institutional 99th percentile threshold OR significant delta (absolute rise ≥ 5 ng/L for hs-TnT)

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