TABLE 1

Recommendations for Emergency Department Imaging for Suspected ACS

IndicationTestClassLevel of Evidence
1. Assessment of myocardial risk in possible ACS patients with nondiagnostic ECG and initial serum markers and enzymes, if available.Rest MPIIA
2. Diagnosis of CAD in possible ACS patients with chest pain with nondiagnostic ECG and negative serum markers and enzymes or normal resting scan.Same day rest/stress perfusion imagingIB
3. Routine imaging of patients with myocardial ischemia/necrosis already documented clinically, by ECG and/or serum markers or enzymesRest MPIIIIC

See Figure 6 of ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction at http://www.acc.org/clinical/guidelines/unstable/incorporated/figure6.htmand Figure 1 of ACC/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction at www.acc.org/clinical/guidelines/nov96/1999/jac1716f01.htm.

ACS indicates acute coronary syndromes; CAD, coronary artery disease; ECG, electrocardiogram; MPI, myocardial perfusion imaging.