Historical risk scores such as the TIMI score, the GRACE score, and the PURSUIT score are being replaced by more accurate risk stratification tools such as the HEART score, which was designed specifically for evaluation of patients with chest pain in the emergency department without a diagnosis of ACS [8]. Noninvasive imaging may therefore be indicated for risk stratification and clinical management in both low-risk and intermediate-risk patients [17]. This has continued to gain popularity since the first decade of the 2000s, with The American College of Radiology 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 individual or society endorsement of the final document. Reprint requests to: publications@acr.org Chest Pain-Possible Acute Coronary Syndrome advanced medical imaging among chest pain patients quintupling [18]. This approach also serves to identify patients with a significant ischemic burden who could benefit from coronary revascularization [19-21]. Noninvasive imaging aids in the evaluation of the acute chest pain patients by either functionally determining a myocardial segment perfusion abnormality (eg, relative hypoperfusion, or a wall motion, or thickening abnormality, usually at stress testing) or anatomically visualizing an obstructive coronary artery stenosis. Although noninvasive imaging approaches have sensitivities and specificities in the 85% to 90% range, the corresponding false diagnosis rates are in the 10% to 15% range, and therefore consideration may be made to avoid diagnostic imaging altogether in patients at either end of the pretest probability spectrum [22].
Chest Pain Possible Acute Coronary Syndrome PCAs. Historical risk scores such as the TIMI score, the GRACE score, and the PURSUIT score are being replaced by more accurate risk stratification tools such as the HEART score, which was designed specifically for evaluation of patients with chest pain in the emergency department without a diagnosis of ACS [8]. Noninvasive imaging may therefore be indicated for risk stratification and clinical management in both low-risk and intermediate-risk patients [17]. This has continued to gain popularity since the first decade of the 2000s, with The American College of Radiology 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 individual or society endorsement of the final document. Reprint requests to: publications@acr.org Chest Pain-Possible Acute Coronary Syndrome advanced medical imaging among chest pain patients quintupling [18]. This approach also serves to identify patients with a significant ischemic burden who could benefit from coronary revascularization [19-21]. Noninvasive imaging aids in the evaluation of the acute chest pain patients by either functionally determining a myocardial segment perfusion abnormality (eg, relative hypoperfusion, or a wall motion, or thickening abnormality, usually at stress testing) or anatomically visualizing an obstructive coronary artery stenosis. Although noninvasive imaging approaches have sensitivities and specificities in the 85% to 90% range, the corresponding false diagnosis rates are in the 10% to 15% range, and therefore consideration may be made to avoid diagnostic imaging altogether in patients at either end of the pretest probability spectrum [22].