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* 'since pain' means time from onset of pain. If the history indicates any subsequent worsening of pain, 'since pain' should be interpreted as time from maximal pain

** 2 or more prior escalations to unscheduled care testing (ED, UTC) for chest pain in a 12-month period that did NOT result in a new ACS diagnosis or new flow-limiting stenosis

*** HEART Score <4 points or other validated tool (ie HEART Pathway or TIMI score) for disease related poor-outcome within 30 days requiring ECG for risk stratification

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