1999;45:199 205. 197. Kleiman NS, Lakkis N, Cannon CP, et al. Prospective analysis of creatine kinase muscle-brain fraction and comparison with troponin T to predict cardiac risk and benefit of an invasive strategy in patients with non-ST-ele- vation acute coronary syndromes. J Am Coll Cardiol. 2002;40:1044 50. 198. Storrow AB, Lindsell CJ, Han JH, et al. Discordant cardiac biomarkers: frequency and outcomes in emergency department patients with chest pain. Ann Emerg Med. 2006;48:660 5. 199. Aviles RJ, Askari AT, Lindahl B, et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med. 2002;346: 2047 52. 200. Farkouh ME, Smars PA, Reeder GS, et al. A clinical trial of a chest- pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators. N Engl J Med. 1998;339:1882 8. 201. Gomez MA, Anderson JL, Karagounis LA, et al. An emergency depart- ment-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). JAm Coll Cardiol. 1996;28:25 33. 202. Amsterdam EA, Kirk JD, Diercks DB, et al. Immediate exercise test- ing to evaluate low-risk patients presenting to the emergency department with chest pain. J Am Coll Cardiol. 2002;40:251 6. 203. Trippi JA, Lee KS. Dobutamine stress tele-echocardiography as a clinical service in the emergency department to evaluate patients with chest pain. Echocardiography. 1999;16:179 85. 204. Bholasingh R, Cornel JH, Kamp O, et al. Prognostic value of predis- charge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T. J Am Coll Cardiol. 2003;41:596 602. 205. Hoffmann U, Truong QA, Schoenfeld DA, et al. Coronary CT angiog- raphy versus standard evaluation in acute chest pain. N Engl J Med. 2012;367:299 308. 206. 