Noninvasive testing in coronary artery disease

In patients with acute chest pain, selection of diagnostic tests and admission to and discharge from the coronary care unit are critical decisions for which useful empirical guidelines are now available. In hospitalized patients, the serum level of the MB fraction of creatine kinase is particularly useful when the history strongly suggests infarction but the ECG is nondiagnostic. In patients with chronic chest pain, the gender of the patient and the character of the pain are the most important guides to selecting and interpreting exercise tests. In women and in men with nonanginal chest pain, the myocardial scintiscan is preferred to the exercise ECG because of its greater diagnostic accuracy. In men with atypical angina, the two tests are nearly equivalent, and the added cost of the scintiscan is a factor in test selection. Since nearly all men with typical angina have coronary artery disease, diagnostic tests are usually not needed.