title: ACR Appropriateness Criteria® chronic chest pain--high probability of coronary artery disease.
abstract: Imaging is valuable in determining the presence, extent, and severity of myocardial ischemia and the severity of obstructive coronary lesions in patients with chronic chest pain in the setting of high probability of coronary artery disease. Imaging is critical for defining patients best suited for medical therapy or intervention, and findings can be used to predict long-term prognosis and the likely benefit from various therapeutic options. Chest radiography, radionuclide single photon-emission CT, radionuclide ventriculography, and conventional coronary angiography are the imaging modalities historically used in evaluating suspected chronic myocardial ischemia. Stress echocardiography, PET, cardiac MRI, and multidetector cardiac CT have all been more recently shown to be valuable in the evaluation of ischemic heart disease. Other imaging techniques may be helpful in those patients who do not present with signs classic for angina pectoris or in those patients who do not respond as expected to standard management. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Fairfax Radiological Consultants, Fairfax, Virginia, USA. jpearls@yahoo.com
authors.forename: James P
authors.initials: JP
authors.lastname: Earls
authors.forename: Richard D
authors.initials: RD
authors.lastname: White
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Woodard
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Michael K
authors.initials: MK
authors.lastname: Atalay
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.forename: Linda B
authors.initials: LB
authors.lastname: Haramati
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hendel
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Ho
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffman
authors.forename: Arfa R
authors.initials: AR
authors.lastname: Khan
authors.forename: Leena
authors.initials: L
authors.lastname: Mammen
authors.forename: Edward T
authors.initials: ET
authors.lastname: Martin
authors.forename: Anna
authors.initials: A
authors.lastname: Rozenshtein
authors.forename: Thomas
authors.initials: T
authors.lastname: Ryan
authors.forename: Joseph
authors.initials: J
authors.lastname: Schoepf
authors.forename: Robert M
authors.initials: RM
authors.lastname: Steiner
authors.forename: Charles S
authors.initials: CS
authors.lastname: White
mesh_terms: D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000009:adverse effects* / Q000592:standards*; D025401:Echocardiography, Stress / Q000009:adverse effects / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000009:adverse effects / Q000592:standards; D008297:Male; D049268:Positron-Emission Tomography / Q000009:adverse effects / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011835:Radiation Protection; D015203:Reproducibility of Results; D018570:Risk Assessment; D012955:Societies, Medical; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000592:standards