Given the often inconclusive initial evaluation of patients presenting with acute chest pain in the Emergency Department, advanced imaging techniques have been evaluated in the quest for improving the current standard of care. In this article, we systematically compare and evaluate the available evidence and cost-effectiveness of radionucleotide myocardial perfusion imaging, cardiac computed tomography angiography, and cardiac magnetic resonance imaging using data from PubMed and EMBASE through January 2012. The obtained data were summarized and categorized according to the reached level of evidence and its impact on the decision-making process.