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Cardiology · Emergency Medicine

ADAPT 2-Hour Chest Pain Protocol calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

Age

years

Allowed range: 18–120 years

65 years or older adds a TIMI row. Under 65 does not.

Family history of coronary disease

Three or more of family history, hypertension, hypercholesterolemia, diabetes, and current smoking make the TIMI risk-factor row positive.

Hypertension

Three or more of family history, hypertension, hypercholesterolemia, diabetes, and current smoking make the TIMI risk-factor row positive.

Hypercholesterolemia

Three or more of family history, hypertension, hypercholesterolemia, diabetes, and current smoking make the TIMI risk-factor row positive.

Diabetes

Three or more of family history, hypertension, hypercholesterolemia, diabetes, and current smoking make the TIMI risk-factor row positive.

Current smoking

Three or more of family history, hypertension, hypercholesterolemia, diabetes, and current smoking make the TIMI risk-factor row positive.

Aspirin in the past 7 days

Previous coronary stenosis of 50% or more

Severe angina

Two or more anginal events in the past 24 hours, or discomfort that is still present.

New ischemic ECG changes

ST depression of at least 0.05 mV in two or more contiguous leads, T-wave inversion of at least 0.1 mV, or Q waves wider than 30 ms and at least 0.1 mV deep in two or more contiguous leads, when the change is not already known.

Troponin I at arrival at or above the institutional cutoff

Use the cutoff that defines an elevated troponin in the laboratory doing the assay. The trial did not use one number for every assay.

Troponin I at 2 hours at or above the institutional cutoff

Use the cutoff that defines an elevated troponin in the laboratory doing the assay. The trial did not use one number for every assay.

Result

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Primary source

Than M et al. 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. DOI: 10.1016/j.jacc.2012.02.035. PMID: 22578923. Table 1 is negative only when every row is negative: cardiac troponin I at 0 h and at 2 h below the institutional cutoff, no new ischemic changes on the first ECG, and a TIMI score of 0. TIMI rows in that table are age 65 years or older; three or more of family history of coronary disease, hypertension, hypercholesterolemia, diabetes, or current smoking; aspirin in the past 7 days; previous coronary stenosis of 50% or more; and severe angina (two or more events in 24 hours or persisting discomfort). ST-segment deviation and a raised biomarker inside TIMI are redundant with the ECG and troponin rows. New ischemia is ST depression of at least 0.05 mV in two or more contiguous leads, T-wave inversion of at least 0.1 mV, or Q waves wider than 30 ms and at least 0.1 mV deep in two or more contiguous leads, when those changes are not already known. The result is 0 when Table 1 is negative and 1 when any row is positive. (2012)

Scope: Adults in the emergency department with at least 5 minutes of symptoms consistent with acute coronary syndrome, when serial troponin testing is planned. ST-elevation myocardial infarction is outside this protocol.

Last reviewed 2026-10-17

Professional use only

For qualified clinicians. Independently verify inputs, calculations, source guidance, and applicability before any clinical action. This calculator does not replace clinical judgment.

Source: Than M et al. 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. DOI: 10.1016/j.jacc.2012.02.035. PMID: 22578923. Table 1 is negative only when every row is negative: cardiac troponin I at 0 h and at 2 h below the institutional cutoff, no new ischemic changes on the first ECG, and a TIMI score of 0. TIMI rows in that table are age 65 years or older; three or more of family history of coronary disease, hypertension, hypercholesterolemia, diabetes, or current smoking; aspirin in the past 7 days; previous coronary stenosis of 50% or more; and severe angina (two or more events in 24 hours or persisting discomfort). ST-segment deviation and a raised biomarker inside TIMI are redundant with the ECG and troponin rows. New ischemia is ST depression of at least 0.05 mV in two or more contiguous leads, T-wave inversion of at least 0.1 mV, or Q waves wider than 30 ms and at least 0.1 mV deep in two or more contiguous leads, when those changes are not already known. The result is 0 when Table 1 is negative and 1 when any row is positive. (2012)

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Clinical inputs

Age (years)Accepted range: 18 to 120
Family history of coronary disease
Hypertension
Hypercholesterolemia
Diabetes
Current smoking
Aspirin in the past 7 days
Previous coronary stenosis of 50% or more
Severe angina
New ischemic ECG changes
Troponin I at arrival at or above the institutional cutoff
Troponin I at 2 hours at or above the institutional cutoff

Primary source

Than M et al. 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. DOI: 10.1016/j.jacc.2012.02.035. PMID: 22578923. Table 1 is negative only when every row is negative: cardiac troponin I at 0 h and at 2 h below the institutional cutoff, no new ischemic changes on the first ECG, and a TIMI score of 0. TIMI rows in that table are age 65 years or older; three or more of family history of coronary disease, hypertension, hypercholesterolemia, diabetes, or current smoking; aspirin in the past 7 days; previous coronary stenosis of 50% or more; and severe angina (two or more events in 24 hours or persisting discomfort). ST-segment deviation and a raised biomarker inside TIMI are redundant with the ECG and troponin rows. New ischemia is ST depression of at least 0.05 mV in two or more contiguous leads, T-wave inversion of at least 0.1 mV, or Q waves wider than 30 ms and at least 0.1 mV deep in two or more contiguous leads, when those changes are not already known. The result is 0 when Table 1 is negative and 1 when any row is positive. (2012)