Diagnostic Imaging to Exclude Acute Coronary Syndrome

Abstract

On virtually every shift, Emergency Department providers care for patients with chest pain. With each encounter, the provider has the difficult task of determining if the patient’s pain is of cardiac or non-cardiac origin. This is a high-stakes decision, as patients discharged with an incorrect diagnosis of non-cardiac chest pain are at high risk for morbidity and mortality, while the provider is at high risk for a medical malpractice claim (Pope et al., N Engl J Med 342(16):1163–1170, 2000; Amsterdam et al., Circulation 122(17):1756–1776, 2010). Diagnostic imaging studies, such as coronary computed tomography angiography, cardiac magnetic resonance imaging, stress echocardiography, and nuclear imaging, play an important role in the risk stratification of patients presenting with chest pain or other symptoms concerning for acute coronary syndrome (ACS). This article will evaluate and summarize the recent evidence relevant to diagnostic imaging modalities used to exclude ACS.