We have read with considerable interest the article by Piñeiro-Portela et al.,1 which compares 2 diagnostic imaging tests in the chest pain unit: stress echocardiography and multidetector computed tomography. Given that the included patients had a low-to-intermediate probability of having acute coronary syndrome (ACS), a normal or nondiagnostic electrocardiogram, and normal troponin levels, we believe that some of the participants did not require diagnostic imaging tests. The authors did not provide results on any of the clinical indexes typically applied to patients with ACS (eg, GRACE, TIMI, and HEART) or used in chest pain units.2–4 It would have been useful to report the results of the CPU-65 risk index (use of aspirin, diabetes, typical pain, age ≥ 65 years) and the index described by Sanchis et al.5 (male sex1, effort-related pain1, recurrent pain2, and prior ischemic heart disease2). Specifically, it would be valuable to know how many patients had index scores ≤ 1 and their outcomes. In addition, the authors should have indicated if high-sensitivity troponin was used, as well as one of the troponin algorithms with proven high sensitivity and negative predictive value for ACS diagnosis. Some evidence indicates that ischemic diagnostic tests might be overused in patients with low or intermediate risk,6 which is why some very low clinical index scores (0 or even 1) might be sufficient to discharge patients with normal electrocardiogram and troponin results from the emergency department. The overuse of ischemic diagnostic tests in low-risk patients prolongs their stay in emergency departments (and even compels their admission), increases the economic cost, and may even result in invasive procedures with no clear impact on patient prognosis.