Coronary CT angiography is associated with rapid assessment, high negative predictive value, decreased length of stay, and ; however, in the latter studies, it increased the rate of invasive coronary angiography and revascularization with uncertain long-term benefits in low-risk patients without ECG or Accelerated diagnostic protocols are also potentially applicable in intermediate-risk patients, whose pre- sentation includes a history of cardiovascular disease, diabetes mellitus, chronic kidney disease (CKD), and/or advanced age.202 See Online Data Supplement 8 for additional information on discharge from the ED or chest pain unit. 4. Early Hospital Care The standard of care for patients who present with NSTE-ACS, including those with recurrent symptoms, ischemic electrocardio- graphic changes, or positive cardiac troponins, is admission for inpatient management. The goals of treatment are the immediate relief of ischemia and the prevention of MI and death. Initially, stabilized patients with NSTE-ACS are admitted to an interme- diate (or step-down) care unit. Patients undergo continuous elec- trocardiographic rhythm monitoring and observation for recurrent ischemia. Bed or chair rest is recommended for patients admit- ted with NSTE-ACS. Patients with NSTE-ACS should be treated with antianginal (Section 4.1.2.5), antiplatelet, and anticoagulant therapy (Section 4.3). Patients are managed with either an early invasive strategy or an ischemia-guided strategy (Section 4.4). Patients with continuing angina, hemodynamic instability, uncontrolled arrhythmias, or a large MI should be admitted to a coronary care unit. The nurse-to-patient ratio should be sufficient to provide 1) continuous electrocardiographic rhythm monitoring, 2) frequent assessment of vital signs and mental status, and 3) abil- ity to perform rapid cardioversion and defibrillation.These patients are usually observed in the coronary care unit for at least 24 hours. Those without recurrent ischemia, significant arrhythmias, pul- monary edema, or hemodynamic instability can be considered for admission or transfer to an intermediate care or telemetry unit. 