There are no major differences in symptoms of an ACS among different ethnic 1.2.1.7 Refer people to hospital as an emergency if an ACS is suspected (see recommendation 1.2.1.3) and: they currently have chest pain or they are currently pain free, but had chest pain in the last 12 hours, and a resting 12-lead ECG is abnormal or not available. [2010] 1.2.1.8 If an ACS is suspected (see recommendation 1.2.1.3) and there are no reasons for emergency referral, refer people for urgent same-day assessment if: they had chest pain in the last 12 hours, but are now pain free with a normal resting 12-lead ECG or the last episode of pain was 12 to 72 hours ago. [2010] 1.2.1.9 Refer people for assessment in hospital if an ACS is suspected (see recommendation 1.2.1.3) and: the pain has resolved and there are signs of complications such as pulmonary oedema. Use clinical judgement to decide whether referral should be as an emergency or urgent same-day assessment. [2010] 1.2.1.10 If a recent ACS is suspected in people whose last episode of chest pain was more than 72 hours ago and who have no complications such as pulmonary oedema: carry out a detailed clinical assessment (see recommendations 1.2.4.2 and confirm the diagnosis by resting 12-lead ECG and blood troponin level take into account the length of time since the suspected ACS when interpreting the troponin level. Use clinical judgement to decide whether referral is necessary and how urgent this should be. [2010] 1.2.1.11 Refer people to hospital as an emergency if they have a recent (confirmed or suspected) ACS and develop further chest pain. 