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 C. Hendel, Vincent B. Ho, Udo Hoffman, Thomas Ryan, U. Joseph Schoepf, Charles S. White

Research output: Contribution to journalReview article

16 Scopus citations

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 - Jan 2011

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Mammen, L., White, R. D., Woodard, P. K., Carr, J. J., Earls, J. P., Hendel, R. C., Ho, V. B., Hoffman, U., Ryan, T., Schoepf, U. J., & 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