Radiography Chest Radiographs of the chest remain an important imaging tool in the workup of patients presenting with acute, nonspecific, low cardiac probability of chest pain, albeit as an indirect indicator of an acute cardiac event, such as the documentation of heart failure. Although there is no relevant literature to support the use of chest radiographs for the evaluation of the coronaries or the heart in the setting of acute nonspecific chest pain with low probability of CAD, this is still a helpful examination. US Echocardiography Transthoracic Stress In a national study of 24,000 patients evaluated in chest pain units, two-thirds of patients, mostly those experiencing acute chest pain, underwent echocardiography (not specified whether resting or stress), with high reliability in guiding further invasive management [15]. This is in keeping with the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association guidelines [22]. A single-center study of 250 patients specifically addressing stress imaging with low-risk presentation documented prognostic significance for major adverse cardiovascular events (MACE) at 1-year follow-up [23]. A single-center randomized control study of 400 consecutive participants comparing coronary artery CT with stress echocardiography for early emergency room discharge of low- to intermediate-risk patients documented a smaller percentage of patients being hospitalized, the primary endpoint, and shorter duration of emergency room observation or hospitalization for stress echocardiography. Major adverse cardiac events at 24 months were comparable for the modalities [24].
Acute Nonspecific Chest Pain Low Probability of Coronary Artery Disease PCAs. Radiography Chest Radiographs of the chest remain an important imaging tool in the workup of patients presenting with acute, nonspecific, low cardiac probability of chest pain, albeit as an indirect indicator of an acute cardiac event, such as the documentation of heart failure. Although there is no relevant literature to support the use of chest radiographs for the evaluation of the coronaries or the heart in the setting of acute nonspecific chest pain with low probability of CAD, this is still a helpful examination. US Echocardiography Transthoracic Stress In a national study of 24,000 patients evaluated in chest pain units, two-thirds of patients, mostly those experiencing acute chest pain, underwent echocardiography (not specified whether resting or stress), with high reliability in guiding further invasive management [15]. This is in keeping with the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association guidelines [22]. A single-center study of 250 patients specifically addressing stress imaging with low-risk presentation documented prognostic significance for major adverse cardiovascular events (MACE) at 1-year follow-up [23]. A single-center randomized control study of 400 consecutive participants comparing coronary artery CT with stress echocardiography for early emergency room discharge of low- to intermediate-risk patients documented a smaller percentage of patients being hospitalized, the primary endpoint, and shorter duration of emergency room observation or hospitalization for stress echocardiography. Major adverse cardiac events at 24 months were comparable for the modalities [24].