Imaging Patients with Chest Pain in the Emergency Department
The six-to-eight million people who present to emergency departments (EDs) across the U.S. each year for the evaluation of chest pain present a unique challenge to physicians.(1) Less than a third of these patients are eventually diagnosed with coronary artery disease (CAD).(2,3) However, a small percentage of patients with acute cardiac ischemia and an acute coronary syndrome (ACS) are inadvertently discharged, with potential adverse consequences.(2,4-6) Concerns about patient safety and malpractice litigation has resulted in the adoption of a practice paradigm that involves observation and testing that is associated with high cost. In this chapter we review the current approaches to risk stratification of chest pain patients, the utility of myocardial perfusion imaging for this purpose and, the ongoing investigation of potential new approaches in this area.