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Disrupting Common Practice

Retiring Stress Tests for Acute Chest Pain Presentations
  • Jigar Contractor
    Correspondence
    Correspondence: Address to Jigar Contractor, MD, Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, 525 E. 68th Street, Box 339, New York, NY 10021.
    Affiliations
    Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
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  • Justin J. Choi
    Affiliations
    Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
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      Each year, more than 6 million patients are evaluated for coronary artery disease (CAD) and acute coronary syndrome (ACS) in emergency departments (EDs) across the United States. Yet, the vast majority of patients are at low-to-intermediate-risk of ACS, creating a high-stakes challenge to identify the few patients at high risk of short-term major adverse cardiovascular events (MACE). CAD is the inductive etiology for ACS, which is a syndrome of acute heart injury that produces symptoms, electrocardiogram (ECG) changes, or imaging findings characteristic of acute coronary hypoperfusion. ACS consists of acute myocardial infarction (AMI) and unstable angina (UA), where AMI causes myocyte death and can be identified by an increase, and if presenting late after symptom onset, a decrease in myocardial biomarkers such as troponin I or T.
      • Thygesen K.
      • Alpert J.S.
      • Jaffe A.S.
      • et al.
      Fourth universal definition of myocardial infarction (2018).

      Abbreviations and Acronyms:

      ACS (acute coronary syndrome), AMI (acute myocardial infarction), CAD (coronary artery disease), CCTA (cardiac computed tomography angiography), ECG (electrocardiogram), ED (emergency department), hsTn (high sensitivity troponin), MACE (major adverse cardiovascular event), OMT (optimal medical therapy), PCI (percutaneous coronary intervention), UA (unstable angina)
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