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: James P Earls, Richard D White, Pamela K Woodard, Suhny Abbara, Michael K Atalay, J Jeffrey Carr, Linda B Haramati, Robert C Hendel, Vincent B Ho, Udo Hoffman, Arfa R Khan, Leena Mammen, Edward T Martin 3rd, Anna Rozenshtein, Thomas Ryan, Joseph Schoepf, Robert M Steiner, Charles S White
• Journal: Journal of the American College of Radiology : JACR (J Am Coll Radiol) Vol. 8 Issue 10 Pg. 679-86 (Oct 2011) ISSN: 1558-349X [Electronic] United States
• PMID: 21962781 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Topics

• Chest Pain (diagnosis, epidemiology)
• Chronic Disease
• Coronary Artery Disease (diagnosis)
• Diagnosis, Differential
• Diagnostic Imaging (adverse effects, standards)
• Echocardiography, Stress (adverse effects, standards)
• Evidence-Based Medicine
• Female
• Humans
• Magnetic Resonance Angiography (adverse effects, standards)
• Male
• Positron-Emission Tomography (adverse effects, standards)
• Practice Guidelines as Topic (standards)
• Radiation Protection
• Reproducibility of Results
• Risk Assessment
• Societies, Medical
• Tomography, Emission-Computed, Single-Photon (adverse effects, standards)
• Tomography, X-Ray Computed (adverse effects, standards)