The 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain: An Interventionalist's Viewpoint
Journal of the Society for Cardiovascular Angiography & Interventions
Chest pain is one of the most common chief complaints in both inpatient and outpatient settings in the United States. Given that coronary artery disease (CAD) remains the leading cause of death in the United States, discriminating between patients presenting with actionable cardiac disease vs those with other “noncardiac” etiologies for their symptoms is of the utmost importance. Over the past 5-10 years, we have seen a rise in various biomarkers (eg, high-sensitivity troponins), clinical decision pathways (eg, HEART score), and novel diagnostic imaging modalities (eg, coronary computed tomography angiography [CCTA]) to improve diagnostic discrimination; however, there is considerable care variability in clinical practice across the United States. To help standardize this process, the American College of Cardiology and American Heart Association Joint Committee on Clinical Practice Guidelines released a guideline document on the evaluation and diagnosis of chest pain.1 Many of the central themes of this document align with prior guideline recommendations, although there are some nuanced central themes worth noting (Figure 1). Based on a recent SCAI webinar on this topic, we have highlighted the key areas of the guideline most likely to impact interventional cardiologists.
Riley RF, Batchelor WB, Goldstein JA, Al-Lamee R, Shah S, Tremmel JA, et al. The 2021 AHA/ACC guideline for the evaluation and diagnosis of chest pain: an interventionalist's viewpoint. J Soc Cardiovasc Angiogr Interv. 2022 May-Jun;1(3):100305. doi:10.1016/j.jscai.2022.100305.