Patient age 65 or above at presentation.
Count of three or more: HTN, hypercholesterolemia, DM, family CAD, current smoker.
Known CAD with stenosis ≥ 50% Documented coronary stenosis ≥ 50% on prior angiography.
Aspirin use in past 7 days Any aspirin dose taken in the past 7 days (proxy for higher baseline risk + aspirin-failure).
Severe angina (≥ 2 episodes within 24 h) Two or more anginal episodes in the preceding 24 hours.
Troponin (or CK-MB if troponin unavailable) above the local 99th-percentile upper reference limit.
ST elevation OR ST depression of at least 0.5 mm on the presenting ECG.