Therefore, patient selection, as determined by clinical judgment and tools such as the HEART score, is critical because there has been historically a low yield of routine noninvasive cardiac imaging in low-risk patients [23-26]. The available noninvasive cardiac imaging modalities include chest radiographs, rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress SPECT MPI, echocardiography (transthoracic and transesophageal), multidetector CT, PET (metabolic and perfusion), and MRI. All procedure elements are essential: 1) timing, 2) recons/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA; however, is 3-D rendering a required element. This corresponds to the definitions that CMS has applied to the CPT codes. Discussion of Procedures by Variant Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging. Arteriography Coronary In patients with low to intermediate risk, arteriography is not the first-line evaluation or management. Patients with a nondiagnostic ECG and negative cardiac biomarkers should follow a clinical pathway beginning with a noninvasive approach [30]. Radiography Chest Chest radiography is primarily used for ruling out conditions that may masquerade as acute myocardial ischemia, as well as defining secondary findings that may accompany acute MI. Acute pulmonary edema can be seen on chest radiographs without enlargement of the cardiac silhouette in patients with acute MI and no prior history of ischemic damage or associated mitral valve disease. Although chest radiography is insufficient to confirm or exclude the presence of significant CAD, it may be useful in demonstrating clinically important pathology in a significant minority of ACS-suspected patients [31].
Chest Pain Possible Acute Coronary Syndrome PCAs. Therefore, patient selection, as determined by clinical judgment and tools such as the HEART score, is critical because there has been historically a low yield of routine noninvasive cardiac imaging in low-risk patients [23-26]. The available noninvasive cardiac imaging modalities include chest radiographs, rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress SPECT MPI, echocardiography (transthoracic and transesophageal), multidetector CT, PET (metabolic and perfusion), and MRI. All procedure elements are essential: 1) timing, 2) recons/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA; however, is 3-D rendering a required element. This corresponds to the definitions that CMS has applied to the CPT codes. Discussion of Procedures by Variant Variant 1: Chest pain, low to intermediate probability for acute coronary syndrome. Initial imaging. Arteriography Coronary In patients with low to intermediate risk, arteriography is not the first-line evaluation or management. Patients with a nondiagnostic ECG and negative cardiac biomarkers should follow a clinical pathway beginning with a noninvasive approach [30]. Radiography Chest Chest radiography is primarily used for ruling out conditions that may masquerade as acute myocardial ischemia, as well as defining secondary findings that may accompany acute MI. Acute pulmonary edema can be seen on chest radiographs without enlargement of the cardiac silhouette in patients with acute MI and no prior history of ischemic damage or associated mitral valve disease. Although chest radiography is insufficient to confirm or exclude the presence of significant CAD, it may be useful in demonstrating clinically important pathology in a significant minority of ACS-suspected patients [31].