title: Trials of Imaging Use in the Emergency Department for Acute Chest Pain.
abstract: Over 8 million patients seek emergency department care for acute chest pain annually in the United States alone, and <5% have an acute coronary syndrome. In the absence of overt electrocardiographic or biomarker evidence, expensive and time-consuming diagnostic strategies are frequently required. Beginning in 2000, radionuclide myocardial perfusion, stress echocardiography, cardiac magnetic resonance imaging, and coronary computed tomographic angiography have become increasingly common in evaluating these patients. This review paper focuses on randomized clinical trials that provide the evidence base for these diagnostic strategies. Novel imaging modalities combining high-sensitivity troponin with imaging or combined anatomic-physiological evaluation using fractional flow reserve by computed tomography are also discussed.
authors.affiliation: Department of Cardiology, William Beaumont Hospital, Oakland University William Beaumont Medical School, Royal Oak, Michigan. Electronic address: Gilbert.Raff@beaumont.edu.
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D057791:Cardiac Imaging Techniques / Q000639:trends; D004059:Diffusion of Innovation; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D015203:Reproducibility of Results; D012107:Research Design
keywords: emergency department; noninvasive imaging; randomized clinical trial