Continuous monitoring with 12-lead ECG may be a reasonable alternative in patients whose initial ECG is nondiagnostic and who are at intermediate/high risk of ACS.85,86 (Level of Evidence: B) 2. Measurement of B-type natriuretic peptide or N-ter- minal pro B-type natriuretic peptide may be consid- ered to assess risk in patients with suspected ACS.87 91 (Level of Evidence: B) 3.3.1. Rationale for Risk Stratification and Spectrum of Risk: High, Intermediate, and Low Assessment of prognosis guides initial clinical evaluation and treatmentandisusefulforselectingthesiteofcare(coronarycare unit, monitored step-down unit, or outpatient monitored unit), antithrombotic therapies (eg, P2Y12 inhibitors, platelet glycopro- tein [GP] IIb/IIIa inhibitors [Sections 4.3.1.2 and 5.1.2.2]), and invasive management (Sections 4.4.2.1, 4.3.1, 4.4, 4.4.4, 4.4.5). There is a strong relationship between indicators of ischemia due to CAD and prognosis (Table 3 and Figure 2). Patients with a high likelihood of ischemia due to CAD are at greater risk of a major adverse cardiac event (MACE) than patients with a lower likelihood of ischemia due to CAD. Risk is highest at the time of presentation but remains elevated past the acute phase. By 6 months, NSTE-ACS mortality rates may equal or exceed those By 12 months, rates of death, MI, and recurrent instability in contemporary registries are >10%. Early events are related to the ruptured coronary plaque and thrombosis, and later events are more closely associated with the pathophysiology of chronic atherosclerosis and LV systolic function.92 98 3.3.2. Estimation of Level of Risk At initial presentation, the clinical history, anginal symptoms and equivalents, physical examination, ECG, renal function, and cardiac troponin measurements can be integrated into an estimation of the risk of death and nonfatal cardiac ischemic events (Table 3 and Figure 2).42,78 3.3.2.1. 