title: ACR Appropriateness Criteria chronic chest pain-low to intermediate probability of coronary artery disease.
abstract: Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease. To consider in patients, especially those who are at low risk for coronary artery disease, are etiologies of chronic noncardiac chest pain. Noncardiac chest pain is most commonly related to gastroesophageal reflux disease or other esophageal diseases. Alternatively, it may be related to costochondritis, arthritic or degenerative diseases, old trauma, primary or metastatic tumors, or pleural disease. Rarely, noncardiac chest pain may be referred pain from organ systems below the diaphragm, such as the gallbladder. 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: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA. woodardp@mir.wustl.edu
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Woodard
authors.forename: Richard D
authors.initials: RD
authors.lastname: White
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Philip A
authors.initials: PA
authors.lastname: Araoz
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
authors.forename: James P
authors.initials: JP
authors.lastname: Earls
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Hsu
authors.forename: Jill E
authors.initials: JE
authors.lastname: Jacobs
authors.forename: Cylen
authors.initials: C
authors.lastname: Javidan-Nejad
authors.forename: Rajesh
authors.initials: R
authors.lastname: Krishnamurthy
authors.forename: Leena
authors.initials: L
authors.lastname: Mammen
authors.forename: Edward T
authors.initials: ET
authors.lastname: Martin
authors.forename: Thomas
authors.initials: T
authors.lastname: Ryan
authors.forename: Amar B
authors.initials: AB
authors.lastname: Shah
authors.forename: Robert M
authors.initials: RM
authors.lastname: Steiner
authors.forename: Jens
authors.initials: J
authors.lastname: Vogel-Claussen
authors.forename: Charles S
authors.initials: CS
authors.lastname: White
mesh_terms: D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology*; D002908:Chronic Disease; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D011336:Probability; D012307:Risk Factors