ACR appropriateness criteria chronic chest pain - Low to intermediate probability of coronary artery disease

Pamela K. Woodard, Richard D. White, Suhny Abbara, Philip A. Araoz, Ricardo C. Cury, Sharmila Dorbala, James P. Earls, Udo Hoffmann, Joe Y. Hsu, Jill E. Jacobs, Cylen Javidan-Nejad, Rajesh Krishnamurthy, Leena Mammen, Edward T. Martin, Thomas Ryan, Amar B. Shah, Robert M. Steiner, Jens Vogel-Claussen, Charles S. White

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease. To consider in patients, especially those who are at low risk for coronary artery disease, are etiologies of chronic noncardiac chest pain. Noncardiac chest pain is most commonly related to gastroesophageal reflux disease or other esophageal diseases. Alternatively, it may be related to costochondritis, arthritic or degenerative diseases, old trauma, primary or metastatic tumors, or pleural disease. Rarely, noncardiac chest pain may be referred pain from organ systems below the diaphragm, such as the gallbladder. 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.

Original languageEnglish (US)
Pages (from-to)329-334
Number of pages6
JournalJournal of the American College of Radiology
Issue number5
StatePublished - May 2013


  • Appropriateness criteria
  • chronic chest pain
  • intermediate probability of coronary artery disease
  • low probability of coronary artery disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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