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03), ACHD patients underwent more frequent stress testing (22% vs 14%, P less then .001) and underwent invasive coronary angiography with equal frequency (7% vs 8%, P = .99). The trend of greater diagnostic scrutiny for acute coronary disease, in the absence of increased risk, strongly correlated with degree of congenital complexity. Both CP character and HEART Score reliably predicted MI for ACHD patients and controls (both P less then .001). CONCLUSION MI is an uncommon cause of CP among ACHD patients presenting to the ED and