Original articleACR Appropriateness Criteria® on Chest Pain, Suggestive of Acute Coronary Syndrome
Section snippets
Summary of Literature Review
Acute chest pain is a frequent presentation in emergency departments. Along with other important disease entities (eg, aortic dissection, pulmonary embolus), clinical symptoms may raise the possibility of acute myocardial ischemia. Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA) [1]. Being able to establish the diagnosis rapidly and accurately may be lifesaving. The immediate cardiac workup consists of
Summary
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A number of imaging modalities may be utilized in evaluating stable patients with chest pain suggestive of ACS who are not selected for urgent cardiac catheterization (see Table 1).
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Although cardiac catheterization is the mainstay for evaluation of patients in whom ACS is being considered, in clinically stable patients with UA or NSTEMI, alternative noninvasive imaging modalities may be appropriate.
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Noninvasive imaging in this setting includes myocardial perfusion scanning, CCTA, and
Anticipated Exceptions
Nephrogenic systemic fibrosis is a disorder with a scleroderma-like presentation and a spectrum of manifestations that can range from limited clinical sequelae to fatality. It seems to be related to both underlying severe renal dysfunction and the administration of gadolinium-based contrast agents. It has occurred primarily in patients on dialysis, rarely in patients with very limited glomerular filtration rates (ie, <30 mL/min/1.73 m2), and almost never in other patients. There is growing
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 indication has been included for each imaging examination. The relative radiation levels are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk
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The ACR seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria® through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.
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The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Uniformed Services University of the Health Sciences or the Department of Defense.