Investigators have studied adding exercise stress testing and echocardiograms in the ED in the SOC risk-stratification of acute chest pain. Both the exercise stress test and the echocardiogram can be enhanced with the addition of nuclear perfusion that can define recent reduction in arterial flow to specific segments of the myocardium. Due to the known weakness of exercise testing 19 and the cost of adding nuclear perfusion enhancement to both the exercise stress test and the echocardiogram, neither study findings have informed the standard-of-care risk-stratification algorithm20-22. Furthermore, no apriori clinical research had performed a cost-analysis to confirm the obvious excessive expense of adding nuclear study in chest pain patients. However, stress testing is considered a worthy test to include in the risk-stratification algorithm because it is capable of detecting flow limiting stenosis, though does not establish the presence or absence of coronary artery disease.