A summary of the literature on low risk chest pain, including history, physical exam, ECG, biomarkers, and investigations such as exercise tolerance testing, myocardial perfusion imaging, and other investigations, is provided in the American Heart Association’s recently published scientific statement.
The document contains a number of useful statistics on the limitations of clinical assessment in ruling out coronary artery disease, such as these:
“…the Multicenter Chest Pain Study found that 22% of patients presenting with symptoms described as sharp or stabbing pain (13% with pleuritic pain and 7% with pain reproduced on palpation) were eventually diagnosed with ACS.”

Testing of Low-Risk Patients Presenting to the Emergency Department With Chest Pain
A Scientific Statement From the American Heart Association
Circulation. 2010;122:1756-1776 – Full Text