Choosing Wisely:

Don’t perform stress cardiovascular magnetic resonance (CMR) in patients with acute chest pain and high probability of coronary artery disease.

Rationale and Comments: Stress testing can increase risk and delay therapy in patients with acute chest pain and markers of high risk, such as ST segment elevation and/or positive cardiac enzymes. After initial evaluation and therapy, non-stress CMR may aid in diagnosing ischemic or nonischemic myocardial injury.
Sponsoring Organizations:
  • Society for Cardiovascular Magnetic Resonance
  • Sources:
  • American College of Radiology Appropriateness Criteria
  • Disciplines:
  • Cardiovascular
  • Emergency medicine
  • References: • Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006 Oct 3;48(7):1475–97.
    • American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Radiol. 2006 Oct;3(10):751–71.
    • Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. Circulation. 2011 May 10;123(18):e426–579.

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