ACR appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome

Leena Mammen, Richard D. White, Pamela K. Woodard, J. Jeffrey Carr, James P. Earls, Robert Hendel, Vincent B. Ho, Udo Hoffman, Thomas Ryan, U. Joseph Schoepf, Charles S. White

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Acute chest pain suggestive of acute coronary syndrome is a frequent complaint in the emergency department. Acute coronary syndromes include myocardial infarction and unstable angina. Being able to establish the diagnosis rapidly and accurately may be lifesaving. A cardiac workup is indicated in this subset of patients in the acute setting, even if there are no ischemic changes on electrocardiography. If the clinical examination and initial cardiac workup suggest that a patient is having myocardial ischemia, the patient will usually be urgently referred for invasive coronary angiography and revascularization. In stable patients without evidence of ST elevation and ongoing myocardial ischemia, an initially conservative approach is sometimes considered. Cardiac risk stratification of this subgroup of patients who are at low and intermediate risk for coronary artery disease is recommended before discharge, and imaging is necessary to exclude ischemia as an etiology. Noninvasive cardiac imaging modalities include chest radiography, single photon-emission CT myocardial perfusion imaging, echocardiography, multidetector CT, PET, and MRI. Noncardiac etiologies of chest pain include aortic dissection, aortic aneurysm, pulmonary embolism, pericardial disease, and lung parenchymal disease. Noninvasive cardiac imaging in patients who are at low and intermediate risk for coronary artery disease may improve confidence regarding the safety of discharge from the emergency department. In addition to risk stratification, noncoronary etiologies for chest pain can be established with imaging.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalJournal of the American College of Radiology
Volume8
Issue number1
DOIs
StatePublished - 2011

Fingerprint

Acute Coronary Syndrome
Chest Pain
Myocardial Ischemia
Hospital Emergency Service
Coronary Artery Disease
Myocardial Perfusion Imaging
Aortic Aneurysm
Unstable Angina
Acute Pain
Coronary Angiography
Pulmonary Embolism
Photons
Radiography
Lung Diseases
Echocardiography
Dissection
Electrocardiography
Thorax
Ischemia
Myocardial Infarction

Keywords

  • acute chest pain
  • acute coronary syndrome
  • angina
  • Appropriateness Criteria®
  • cardiac imaging
  • cardiac risk stratification

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Mammen, L., White, R. D., Woodard, P. K., Carr, J. J., Earls, J. P., Hendel, R., ... White, C. S. (2011). ACR appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome. Journal of the American College of Radiology, 8(1), 12-18. https://doi.org/10.1016/j.jacr.2010.08.023

ACR appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome. / Mammen, Leena; White, Richard D.; Woodard, Pamela K.; Carr, J. Jeffrey; Earls, James P.; Hendel, Robert; Ho, Vincent B.; Hoffman, Udo; Ryan, Thomas; Schoepf, U. Joseph; White, Charles S.

In: Journal of the American College of Radiology, Vol. 8, No. 1, 2011, p. 12-18.

Research output: Contribution to journalArticle

Mammen, L, White, RD, Woodard, PK, Carr, JJ, Earls, JP, Hendel, R, Ho, VB, Hoffman, U, Ryan, T, Schoepf, UJ & White, CS 2011, 'ACR appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome', Journal of the American College of Radiology, vol. 8, no. 1, pp. 12-18. https://doi.org/10.1016/j.jacr.2010.08.023
Mammen, Leena ; White, Richard D. ; Woodard, Pamela K. ; Carr, J. Jeffrey ; Earls, James P. ; Hendel, Robert ; Ho, Vincent B. ; Hoffman, Udo ; Ryan, Thomas ; Schoepf, U. Joseph ; White, Charles S. / ACR appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome. In: Journal of the American College of Radiology. 2011 ; Vol. 8, No. 1. pp. 12-18.
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