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Chest Pain-Possible Acute Coronary Syndrome

Variant: 1   Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
US echocardiography transthoracic stress Usually Appropriate O
Radiography chest Usually Appropriate ☢
CTA coronary arteries with IV contrast Usually Appropriate ☢☢☢
SPECT or SPECT/CT MPI rest and stress Usually Appropriate ☢☢☢☢
US echocardiography transthoracic resting May Be Appropriate O
MRI heart function and morphology without and with IV contrast May Be Appropriate O
MRI heart with function and inotropic stress without and with IV contrast May Be Appropriate O
MRI heart with function and inotropic stress without IV contrast May Be Appropriate O
MRI heart with function and vasodilator stress perfusion without and with IV contrast May Be Appropriate O
CT coronary calcium May Be Appropriate ☢☢☢
CTA chest with IV contrast May Be Appropriate ☢☢☢
SPECT or SPECT/CT MPI rest only May Be Appropriate ☢☢☢
Rb-82 PET/CT MPI rest and stress May Be Appropriate (Disagreement) ☢☢☢☢
US echocardiography transesophageal Usually Not Appropriate O
Arteriography coronary Usually Not Appropriate ☢☢☢
MRA coronary arteries without and with IV contrast Usually Not Appropriate O
MRA coronary arteries without IV contrast Usually Not Appropriate O
MRI heart function and morphology without IV contrast Usually Not Appropriate O
CT chest with IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT chest without IV contrast Usually Not Appropriate ☢☢☢

Variant: 2   Chest pain, high probability for acute coronary syndrome. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
Radiography chest Usually Appropriate ☢
Arteriography coronary Usually Appropriate ☢☢☢
US echocardiography transthoracic resting May Be Appropriate O
US echocardiography transthoracic stress May Be Appropriate (Disagreement) O
MRI heart function and morphology without and with IV contrast May Be Appropriate (Disagreement) O
CTA coronary arteries with IV contrast May Be Appropriate ☢☢☢
SPECT or SPECT/CT MPI rest only May Be Appropriate (Disagreement) ☢☢☢
SPECT or SPECT/CT MPI rest and stress May Be Appropriate ☢☢☢☢
US echocardiography transesophageal Usually Not Appropriate O
MRA coronary arteries without and with IV contrast Usually Not Appropriate O
MRA coronary arteries without IV contrast Usually Not Appropriate O
MRI heart function and morphology without IV contrast Usually Not Appropriate O
MRI heart with function and inotropic stress without and with IV contrast Usually Not Appropriate O
MRI heart with function and inotropic stress without IV contrast Usually Not Appropriate O
MRI heart with function and vasodilator stress perfusion without and with IV contrast Usually Not Appropriate O
CT chest with IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT chest without IV contrast Usually Not Appropriate ☢☢☢
CT coronary calcium Usually Not Appropriate ☢☢☢
CTA chest with IV contrast Usually Not Appropriate ☢☢☢
Rb-82 PET/CT MPI rest and stress Usually Not Appropriate ☢☢☢☢

Panel Members
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Discussion of Procedures by Variant
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
A. Arteriography Coronary
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
B. Radiography Chest
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
C. SPECT or SPECT/CT MPI Rest Only
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
D. SPECT or SPECT/CT MPI Rest and Stress
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
E. US Echocardiography Transthoracic Stress
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
F. US Echocardiography Transthoracic Resting
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
G. US Echocardiography Transesophageal
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
H. CTA Coronary Arteries
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
I. CT Coronary Calcium
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
J. CT Chest
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
K. CTA Chest
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
L. Rb-82 PET/CT Heart
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
M. MRI Heart with Function and Inotropic Stress
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
N. MRI Heart with Function and Vasodilator Stress Perfusion
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
O. MRI Heart Function and Morphology
Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging.
P. MRA Coronary Arteries
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
A. Arteriography Coronary
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
B. Radiography Chest
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
C. CTA Coronary Arteries
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
D. CT Chest
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
E. CTA Chest
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
F. CT Coronary Calcium
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
G. MRA Coronary Arteries
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
H. MRI Heart Function and Morphology
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
I. MRI Heart with Function and Inotropic Stress
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
J. MRI Heart with Function and Vasodilator Stress Perfusion
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
K. Rb-82 PET/CT Heart
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
L. SPECT or SPECT/CT MPI Rest Only
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
M. SPECT or SPECT/CT MPI Rest and Stress
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
N. US Echocardiography Transthoracic Stress
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
O. US Echocardiography Transthoracic Rest
Variant 2: Chest pain, high probability for acute coronary syndrome. Initial imaging.
P. US Echocardiography Transesophageal
Summary of Recommendations
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations

Relative Radiation Level*

Adult Effective Dose Estimate Range

Pediatric Effective Dose Estimate Range

O

0 mSv

 0 mSv

☢

<0.1 mSv

<0.03 mSv

☢☢

0.1-1 mSv

0.03-0.3 mSv

☢☢☢

1-10 mSv

0.3-3 mSv

☢☢☢☢

10-30 mSv

3-10 mSv

☢☢☢☢☢

30-100 mSv

10-30 mSv

*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”
References
1. Raff GL, Hoffmann U, Udelson JE. Trials of Imaging Use in the Emergency Department for Acute Chest Pain. [Review]. Jacc: Cardiovascular Imaging. 10(3):338-349, 2017 Mar.
2. Maffei E, Seitun S, Guaricci AI, Cademartiri F. Chest pain: coronary CT in the ER. [Review]. British Journal of Radiology. 89(1061):20150954, 2016.Br J Radiol. 89(1061):20150954, 2016.
3. Cannon CP, Battler A, Brindis RG, et al. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee). J Am Coll Cardiol. 2001; 38(7):2114-2130.
4. Antman EM, Hand M, Armstrong PW, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008; 117(2):296-329.
5. Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005; 111(6):761-767.
6. Haaf P, Reichlin T, Corson N, et al. B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain. Am J Med. 124(5):444-52, 2011 May.
7. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 126(16):2020-35, 2012 Oct 16.
8. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16:191-6.
9. de Araujo Goncalves P, Ferreira J, Aguiar C, Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J. 26(9):865-72, 2005 May.
10. Yan AT, Yan RT, Tan M, et al. Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. Eur Heart J. 28(9):1072-8, 2007 May.
11. Fu Y, Goodman S, Chang WC, Van De Werf F, Granger CB, Armstrong PW. Time to treatment influences the impact of ST-segment resolution on one-year prognosis: insights from the assessment of the safety and efficacy of a new thrombolytic (ASSENT-2) trial. Circulation. 104(22):2653-9, 2001 Nov 27.
12. Gibson CM.. Time is myocardium and time is outcomes. Circulation. 104(22):2632-4, 2001 Nov 27.
13. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.[Erratum appears in Circulation. 2012 Feb 28;125(8):e412 Note: Dosage error in article text]. Circulation. 124(23):e574-651, 2011 Dec 06.
14. Pernes JM, Dupouy P, Labbe R, et al. Management of acute chest pain: A major role for coronary CT angiography. [Review]. Diagn Interv Imaging. 96(11):1105-12, 2015 Nov.
15. Welch RD, Zalenski RJ, Frederick PD, et al. Prognostic value of a normal or nonspecific initial electrocardiogram in acute myocardial infarction. JAMA. 286(16):1977-84, 2001 Oct 24-31.
16. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 342(16):1163-70, 2000 Apr 20.
17. Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010; 122(17):1756-1776.
18. Bhuiya FA, Pitts SR, McCaig LF. Emergency department visits for chest pain and abdominal pain: United States, 1999-2008. NCHS data brief. (43)1-8, 2010 Sep.
19. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007; 50(7):e1-e157.
20. de Winter RJ, Windhausen F, Cornel JH, et al. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005; 353(11):1095-1104.
21. Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005; 293(23):2908-2917.
22. Task Force Members, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.[Erratum appears in Eur Heart J. 2014 Sep 1;35(33):2260-1]. Eur Heart J. 34(38):2949-3003, 2013 Oct.
23. Borges Santos M, Ferreira AM, de Araujo Goncalves P, et al. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease-an analysis of the ACROSS registry. Rev Port Cardiol. 32(6):483-8, 2013 Jun.
24. Cremer PC, Khalaf S, Agarwal S, et al. Myocardial perfusion imaging in emergency department patients with negative cardiac biomarkers: yield for detecting ischemia, short-term events, and impact of downstream revascularization on mortality. Circ Cardiovasc Imaging. 7(6):912-9, 2014 Nov.
25. Hartsell S, Dorais J, Preston R, et al. False-positive rates of provocative cardiac testing in chest pain patients admitted to an emergency department observation unit. Crit. pathw. cardiol.. 13(3):104-8, 2014 Sep.
26. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362(10):886-895.
27. Rubinshtein R, Halon DA, Gaspar T, et al. Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin. Am J Cardiol. 2007; 100(10):1522-1526.
28. Solinas L, Raucci R, Terrazzino S, et al. Prevalence, clinical characteristics, resource utilization and outcome of patients with acute chest pain in the emergency department. A multicenter, prospective, observational study in north-eastern Italy. Ital Heart J. 2003; 4(5):318-324.
29. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2.
30. Emergency Department Patients With Chest Pain Writing Panel, Rybicki FJ, Udelson JE, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J. Am. Coll. Radiol.. 13(2):e1-e29, 2016 Feb.
31. Goldschlager R, Roth H, Solomon J, et al. Validation of a clinical decision rule: chest X-ray in patients with chest pain and possible acute coronary syndrome. EMERG. RADIOL.. 21(4):367-72, 2014 Aug.
32. Kontos MC, Fratkin MJ, Jesse RL, Anderson FP, Ornato JP, Tatum JL. Sensitivity of acute rest myocardial perfusion imaging for identifying patients with myocardial infarction based on a troponin definition. J Nucl Cardiol. 2004; 11(1):12-19.
33. Udelson JE, Beshansky JR, Ballin DS, et al. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial. JAMA. 2002;288(21):2693-2700.
34. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 42(7):1318-33, 2003 Oct 01.
35. Dedic A, Genders TS, Nieman K, Hunink MG. Imaging strategies for acute chest pain in the emergency department. [Review]. AJR Am J Roentgenol. 200(1):W26-38, 2013 Jan.
36. Ghatak A, Hendel RC. Role of imaging for acute chest pain syndromes. [Review]. Semin Nucl Med. 43(2):71-81, 2013 Mar.
37. Lim SH, Anantharaman V, Sundram F, et al. Stress myocardial perfusion imaging for the evaluation and triage of chest pain in the emergency department: a randomized controlled trial. J Nucl Cardiol. 20(6):1002-12, 2013 Dec.
38. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 32(8):1012-24, 2011 Apr.
39. Shaw LJ, Weintraub WS, Maron DJ, et al. Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J. 164(2):243-50, 2012 Aug.
40. Davies R, Liu G, Sciamanna C, Davidson WR Jr, Leslie DL, Foy AJ. Comparison of the Effectiveness of Stress Echocardiography Versus Myocardial Perfusion Imaging in Patients Presenting to the Emergency Department With Low-Risk Chest Pain. American Journal of Cardiology. 118(12):1786-1791, 2016 Dec 15.Am J Cardiol. 118(12):1786-1791, 2016 Dec 15.
41. Lancellotti P, Price S, Edvardsen T, et al. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. European Heart Journal Acute Cardiovascular Care. 4(1):3-5, 2015 Feb.
42. Lim SH, Sayre MR, Gibler WB. 2-D echocardiography prediction of adverse events in ED patients with chest pain. Am J Emerg Med. 2003; 21(2):106-110.
43. Innocenti F, Cerabona P, Donnini C, Conti A, Zanobetti M, Pini R. Long-term prognostic value of stress echocardiography in patients presenting to the ED with spontaneous chest pain. Am J Emerg Med. 32(7):731-6, 2014 Jul.
44. Nucifora G, Badano LP, Sarraf-Zadegan N, et al. Comparison of early dobutamine stress echocardiography and exercise electrocardiographic testing for management of patients presenting to the emergency department with chest pain. Am J Cardiol. 100(7):1068-73, 2007 Oct 01.
45. Hartlage G, Janik M, Anadiotis A, et al. Prognostic value of adenosine stress cardiovascular magnetic resonance and dobutamine stress echocardiography in patients with low-risk chest pain. Int J Cardiovasc Imaging. 28(4):803-12, 2012 Apr.
46. Aldous S, Richards AM, Cullen L, Pickering JW, Than M. The incremental value of stress testing in patients with acute chest pain beyond serial cardiac troponin testing. Emerg Med J. 33(5):319-24, 2016 May.
47. Yao SS, Bangalore S, Chaudhry FA. Prognostic implications of stress echocardiography and impact on patient outcomes: an effective gatekeeper for coronary angiography and revascularization. J Am Soc Echocardiogr. 23(8):832-9, 2010 Aug.
48. Frenkel O, Riguzzi C, Nagdev A. Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED. Am J Emerg Med. 32(6):670-2, 2014 Jun.
49. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 23(12):1225-30, 2010 Dec.
50. Gaibazzi N, Squeri A, Reverberi C, et al. Contrast stress-echocardiography predicts cardiac events in patients with suspected acute coronary syndrome but nondiagnostic electrocardiogram and normal 12-hour troponin. J Am Soc Echocardiogr. 24(12):1333-41, 2011 Dec.
51. Kaul S, Senior R, Firschke C, et al. Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: a multicenter study. Am Heart J. 2004;148(1):129-136.
52. Rinkevich D, Kaul S, Wang XQ, et al. Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation. Eur Heart J. 26(16):1606-11, 2005 Aug.
53. Wei K.. Utility contrast echocardiography in the emergency department. [Review] [44 refs]. JACC Cardiovasc Imaging. 3(2):197-203, 2010 Feb.
54. Dahlslett T, Karlsen S, Grenne B, et al. Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome. J Am Soc Echocardiogr. 27(5):512-9, 2014 May.
55. Eek C, Grenne B, Brunvand H, et al. Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. Eur J Echocardiogr. 11(6):501-8, 2010 Jul.
56. Sarvari SI, Haugaa KH, Zahid W, et al. Layer-specific quantification of myocardial deformation by strain echocardiography may reveal significant CAD in patients with non-ST-segment elevation acute coronary syndrome. JACC Cardiovasc Imaging. 6(5):535-44, 2013 May.
57. Schroeder J, Hamada S, Grundlinger N, et al. Myocardial deformation by strain echocardiography identifies patients with acute coronary syndrome and non-diagnostic ECG presenting in a chest pain unit: a prospective study of diagnostic accuracy. Clin. res. cardiol.. 105(3):248-56, 2016 Mar.
58. Kuhl HP, Hanrath P. The impact of transesophageal echocardiography on daily clinical practice. Eur J Echocardiogr. 2004; 5(6):455-468.
59. Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. [Review] [13 refs]. J Am Coll Cardiol. 48(7):1475-97, 2006 Oct 03.
60. Hoffmann U, Bamberg F, Chae CU, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009; 53(18):1642-1650.
61. Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O'Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007; 49(8):863-871.
62. Hoffmann U, Nagurney JT, Moselewski F, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation. 2006; 114(21):2251-2260.
63. Rubinshtein R, Halon DA, Gaspar T, et al. Usefulness of 64-slice multidetector computed tomography in diagnostic triage of patients with chest pain and negative or nondiagnostic exercise treadmill test result. Am J Cardiol. 2007; 99(7):925-929.
64. Stillman AE, Oudkerk M, Ackerman M, et al. Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Eur Radiol. 2007; 17(8):2196-2207.
65. Levsky JM, Spevack DM, Travin MI, et al. Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry: A Randomized Trial. Annals of Internal Medicine. 163(3):174-83, 2015 Aug 04.Ann Intern Med. 163(3):174-83, 2015 Aug 04.
66. Linde JJ, Hove JD, Sorgaard M, et al. Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain: The Randomized Controlled CATCH Trial. Jacc: Cardiovascular Imaging. 8(12):1404-1413, 2015 Dec.JACC Cardiovasc Imaging. 8(12):1404-1413, 2015 Dec.
67. Pena E, Rubens F, Stiell I, Peterson R, Inacio J, Dennie C. Efficiency and safety of coronary CT angiography compared to standard care in the evaluation of patients with acute chest pain: a Canadian study. EMERG. RADIOL.. 23(4):345-52, 2016 Aug.
68. Truong QA, Schulman-Marcus J, Zakroysky P, et al. Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography? Results of the Randomized Comparative Effectiveness ROMICAT II Trial. Journal of the American Heart Association. 5(3):e003137, 2016 Mar 22.
69. Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol. 58(14):1414-22, 2011 Sep 27.
70. Hoffmann U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 367(4):299-308, 2012 Jul 26.
71. Litt HI, Gatsonis C, Snyder B, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012; 366(15):1393-1403.
72. Takakuwa KM, Keith SW, Estepa AT, Shofer FS. A meta-analysis of 64-section coronary CT angiography findings for predicting 30-day major adverse cardiac events in patients presenting with symptoms suggestive of acute coronary syndrome. Acad Radiol. 18(12):1522-8, 2011 Dec.
73. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52(21):1724-1732.
74. Cury RC, Budoff M, Taylor AJ. Coronary CT angiography versus standard of care for assessment of chest pain in the emergency department. [Review]. J Cardiovasc Comput Tomogr. 7(2):79-82, 2013 Mar-Apr.
75. Cury RC, Feuchtner GM, Batlle JC, et al. Triage of patients presenting with chest pain to the emergency department: implementation of coronary CT angiography in a large urban health care system. AJR Am J Roentgenol. 200(1):57-65, 2013 Jan.
76. Romero J, Husain SA, Holmes AA, et al. Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies. Int J Cardiol. 187:565-80, 2015.
77. Body R, Burrows G, Carley S, Lewis PS. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay. Ann Clin Biochem. 52(Pt 5):543-9, 2015 Sep.
78. Dedic A, Lubbers MM, Schaap J, et al. Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity Troponins: Randomized Multicenter Study. Journal of the American College of Cardiology. 67(1):16-26, 2016 Jan 05.
79. Dedic A, Nieman K, Hoffmann U, Ferencik M. Is there still a role for cardiac CT in the emergency department in the era of highly-sensitive troponins?. [Review]. Minerva Cardioangiol. 65(3):214-224, 2017 Jun.
80. Ferencik M, Liu T, Mayrhofer T, et al. hs-Troponin I Followed by CT Angiography Improves Acute Coronary Syndrome Risk Stratification Accuracy and Work-Up in Acute Chest Pain Patients: Results From ROMICAT II Trial. Jacc: Cardiovascular Imaging. 8(11):1272-1281, 2015 Nov.
81. Neglia D, Rovai D, Caselli C, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging. 8(3), 2015 Mar.
82. Chen MY, Rochitte CE, Arbab-Zadeh A, et al. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study. Radiology. 284(1):55-65, 2017 Jul.
83. Feuchtner GM, Plank F, Pena C, et al. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging. Heart. 98(20):1510-7, 2012 Oct.
84. Linde JJ, Sorgaard M, Kuhl JT, et al. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris. Int J Cardiovasc Imaging. 33(2):261-270, 2017 Feb.
85. Rochitte CE, George RT, Chen MY, et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J 2014;35:1120-30.
86. Branch KR, Busey J, Mitsumori LM, et al. Diagnostic performance of resting CT myocardial perfusion in patients with possible acute coronary syndrome. AJR Am J Roentgenol. 200(5):W450-7, 2013 May.
87. Pursnani A, Lee AM, Mayrhofer T, et al. Early resting myocardial computed tomography perfusion for the detection of acute coronary syndrome in patients with coronary artery disease. Circulation. Cardiovascular imaging. 8(3):e002404, 2015 Mar.
88. Coenen A, Rossi A, Lubbers MM, et al. Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease. JACC Cardiovasc Imaging. 10(7):760-770, 2017 Jul.
89. Douglas PS, De Bruyne B, Pontone G, et al. 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study. J Am Coll Cardiol. 68(5):435-45, 2016 Aug 02.
90. Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 2011;58:1989-97.
91. Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. Jama 2012;308:1237-45.
92. Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 2014;63:1145-55.
93. Pontone G, Andreini D, Guaricci AI, et al. Rationale and design of the PERFECTION (comparison between stress cardiac computed tomography PERfusion versus Fractional flow rEserve measured by Computed Tomography angiography In the evaluation of suspected cOroNary artery disease) prospective study. J Cardiovasc Comput Tomogr. 10(4):330-4, 2016 Jul-Aug.
94. Laudon DA, Behrenbeck TR, Wood CM, et al. Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department: long-term outcome of a prospective blind study. Mayo Clin Proc. 85(4):314-22, 2010 Apr.
95. Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, et al. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. [Review]. Ann Emerg Med. 68(6):659-670, 2016 12.
96. Nance JW Jr, Schlett CL, Schoepf UJ, et al. Incremental prognostic value of different components of coronary atherosclerotic plaque at cardiac CT angiography beyond coronary calcification in patients with acute chest pain. Radiology. 264(3):679-90, 2012 Sep.
97. Hecht HS.. Coronary artery calcium scanning: past, present, and future. [Review]. JACC Cardiovasc Imaging. 8(5):579-596, 2015 May.
98. Hinzpeter R, Higashigaito K, Morsbach F, et al. Coronary artery calcium scoring for ruling-out acute coronary syndrome in chest pain CT. Am J Emerg Med. 35(10):1565-1567, 2017 Oct.
99. Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS. Utility of coronary artery calcium scoring in the evaluation of patients with chest pain. [Review]. Crit. pathw. cardiol.. 11(3):99-106, 2012 Sep.
100. Yerramasu A, Lahiri A, Venuraju S, et al. Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. Eur Heart J Cardiovasc Imaging. 15(8):886-92, 2014 Aug.
101. Watanabe T, Furuse Y, Ohta Y, Kato M, Ogawa T, Yamamoto K. The Effectiveness of Non-ECG-Gated Contrast-Enhanced Computed Tomography for the Diagnosis of Non-ST Segment Elevation Acute Coronary Syndrome. International Heart Journal. 57(5):558-64, 2016 Sep 28.
102. Yamazaki M, Higuchi T, Shimokoshi T, et al. Acute coronary syndrome: evaluation of detection capability using non-electrocardiogram-gated parenchymal phase CT imaging. Jpn J Radiol. 34(5):331-8, 2016 May.
103. Yoo SM, Chun EJ, Lee HY, Min D, White CS. Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department: From Typical Acute Coronary Syndrome to Various Unusual Mimics. [Review]. J Thorac Imaging. 32(1):26-35, 2017 Jan.
104. Kanza RE, Allard C, Berube M. Cardiac findings on non-gated chest computed tomography: A clinical and pictorial review. [Review]. Eur J Radiol. 85(2):435-51, 2016 Feb.
105. Kajander S, Joutsiniemi E, Saraste M, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 122(6):603-13, 2010 Aug 10.
106. Nandalur KR, Dwamena BA, Choudhri AF, Nandalur SR, Reddy P, Carlos RC. Diagnostic performance of positron emission tomography in the detection of coronary artery disease: a meta-analysis. Acad Radiol. 15(4):444-51, 2008 Apr.
107. Groves AM, Speechly-Dick ME, Kayani I, et al. First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation. Eur J Nucl Med Mol Imaging. 36(12):2027-33, 2009 Dec.
108. Namdar M, Hany TF, Koepfli P, et al. Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med 2005;46:930-5.
109. Jaarsma C, Leiner T, Bekkers SC, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2012;59(19):1719-1728.
110. Lerakis S, McLean DS, Anadiotis AV, et al. Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain. J Cardiovasc Magn Reson. 2009; 11:37.
111. Vogel-Claussen J, Skrok J, Dombroski D, et al. Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test. J Magn Reson Imaging. 2009; 30(4):753-762.
112. Ahmad IG, Abdulla RK, Klem I, et al. Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease. J Nucl Cardiol. 23(2):287-97, 2016 Apr.
113. Macwar RR, Williams BA, Shirani J. Prognostic value of adenosine cardiac magnetic resonance imaging in patients presenting with chest pain. Am J Cardiol. 112(1):46-50, 2013 Jul 01.
114. Miller CD, Case LD, Little WC, et al. Stress CMR reduces revascularization, hospital readmission, and recurrent cardiac testing in intermediate-risk patients with acute chest pain. JACC Cardiovasc Imaging. 6(7):785-94, 2013 Jul.
115. Charoenpanichkit C, Hundley WG. The 20 year evolution of dobutamine stress cardiovascular magnetic resonance. [Review]. J Cardiovasc Magn Reson. 12:59, 2010 Oct 26.
116. Korosoglou G, Elhmidi Y, Steen H, et al. Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion. J Am Coll Cardiol. 2010;56(15):1225-1234.
117. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 50(12):1174-9, 2007 Sep 18.
118. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic and therapeutic implications of dipyridamole stress cardiovascular magnetic resonance on the basis of the ischaemic cascade. Heart. 95(1):49-55, 2009 Jan.
119. Greenwood JP, Maredia N, Younger JF, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379(9814):453-460.
120. Schwitter J, Wacker CM, van Rossum AC, et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 29(4):480-9, 2008 Feb.
121. Hussain ST, Paul M, Plein S, et al. Design and rationale of the MR-INFORM study: stress perfusion cardiovascular magnetic resonance imaging to guide the management of patients with stable coronary artery disease. J Cardiovasc Magn Reson. 14:65, 2012 Sep 19.
122. Kwong RY, Schussheim AE, Rekhraj S, et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 2003;107(4):531-537.
123. Plein S, Greenwood JP, Ridgway JP, Cranny G, Ball SG, Sivananthan MU. Assessment of non-ST-segment elevation acute coronary syndromes with cardiac magnetic resonance imaging. J Am Coll Cardiol. 44(11):2173-81, 2004 Dec 07.
124. Cury RC, Shash K, Nagurney JT, et al. Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation. 2008;118(8):837-844.
125. Raman SV, Simonetti OP, Winner MW 3rd, et al. Cardiac magnetic resonance with edema imaging identifies myocardium at risk and predicts worse outcome in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 55(22):2480-8, 2010 Jun 01.
126. Lockie T, Nagel E, Redwood S, Plein S. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. [Review] [104 refs]. Circulation. 119(12):1671-81, 2009 Mar 31.
127. Pufulete M, Brierley RC, Bucciarelli-Ducci C, et al. Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. [Review]. BMJ Open. 7(6):e014627, 2017 Jun 22.
128. Dastidar AG, Rodrigues JC, Ahmed N, Baritussio A, Bucciarelli-Ducci C. The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries. [Review]. Curr. cardiovasc. imaging rep.. 8(8):28, 2015.
129. Pathik B, Raman B, Mohd Amin NH, et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. European heart journal cardiovascular Imaging. 17(10):1146-52, 2016 Oct.Eur Heart J Cardiovasc Imaging. 17(10):1146-52, 2016 Oct.
130. Dall'Armellina E, Piechnik SK, Ferreira VM, et al. Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction. J Cardiovasc Magn Reson. 14:15, 2012 Feb 06.
131. Saremi F.. Cardiac MR Imaging in Acute Coronary Syndrome: Application and Image Interpretation. [Review]. Radiology. 282(1):17-32, 2017 Jan.
132. Bluemke DA, Achenbach S, Budoff M, et al. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation. 2008; 118(5):586-606.
133. American College of Cardiology Foundation Task Force on Expert Consensus Documents, Hundley WG, Bluemke DA, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. [Review] [426 refs]. J Am Coll Cardiol. 55(23):2614-62, 2010 Jun 08.
134. Kato S, Kitagawa K, Ishida N, et al. Assessment of coronary artery disease using magnetic resonance coronary angiography: a national multicenter trial. J Am Coll Cardiol. 56(12):983-91, 2010 Sep 14.
135. Dweck MR, Puntman V, Vesey AT, Fayad ZA, Nagel E. MR Imaging of Coronary Arteries and Plaques. [Review]. JACC Cardiovasc Imaging. 9(3):306-16, 2016 Mar.
136. Dracup K, Alonzo AA, Atkins JM, et al. The physician's role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program. Working Group on Educational Strategies To Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction. [Review] [61 refs]. Ann Intern Med. 126(8):645-51, 1997 Apr 15.
137. Krumholz HM, Bradley EH, Nallamothu BK, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality. [Review] [28 refs]. JACC Cardiovasc Interv. 1(1):97-104, 2008 Feb.
138. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.[Erratum appears in Circulation. 2013 Dec 24;128(25):e481]. Circulation. 127(4):e362-425, 2013 Jan 29.
139. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.[Erratum appears in J Am Coll Cardiol. 2014 Dec 23;64(24):2713-4. Dosage error in article text]. J Am Coll Cardiol. 64(24):e139-e228, 2014 Dec 23.
140. Korley FK, Jaffe AS. Preparing the United States for high-sensitivity cardiac troponin assays. [Review]. J Am Coll Cardiol. 61(17):1753-8, 2013 Apr 30.
141. Damman P, Hirsch A, Windhausen F, Tijssen JG, de Winter RJ, ICTUS Investigators. 5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 55(9):858-64, 2010 Mar 02.
142. Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 360(21):2165-75, 2009 May 21.
143. O'Donoghue M, Boden WE, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 300(1):71-80, 2008 Jul 02.
144. Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. [Review] [114 refs]. J Am Coll Cardiol. 55(1):1-16, 2009 Dec 29.
145. Emrich T, Emrich K, Abegunewardene N, et al. Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries. Br J Radiol. 88(1049):20150025, 2015 May.
146. Mahmarian JJ, Shaw LJ, Filipchuk NG, et al. A multinational study to establish the value of early adenosine technetium-99m sestamibi myocardial perfusion imaging in identifying a low-risk group for early hospital discharge after acute myocardial infarction. J Am Coll Cardiol. 48(12):2448-57, 2006 Dec 19.
147. Shaw LJ, Hachamovitch R, Berman DS, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 33(3):661-9, 1999 Mar.
148. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf.
Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.