Non-invasive ischaemia tests and biomarkers are commonly used in emergency departments to rule out acute coronary syndrome, but their diagnostic accuracy is still not fully established.
A systematic review analyzed 77 studies with over 49,000 patients comparing various tests for diagnosing chest pain, revealing that fast and six-hour highly sensitive troponin T protocols have similar sensitivity and specificity.
Among non-invasive tests, coronary computed tomography and myocardial perfusion scintigraphy demonstrated the highest diagnostic accuracy for patients without elevated troponin levels, while stress echography was less effective and exercise testing performed the worst.