Interpretation of <i>2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain</i>_West China Medical Journal

Authors：

LI Dongze ^1,2 , LIU Bofu ^1,2 , ZHOU Fating ^1,2 , JIAN Mengyao ^1,2 , WANG Zhiyuan ^1,2 , XIANG Xinjie ^1,2 , TANG Songling ^1,2 , MA Wen ^1,2 , JIA Yu ^1,2 ,  CAO Yu ^1,2

1. Department of Emergency Medicine / Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: caoyu@wchscu.cn

Keywords：

Chest pain; Angina; Coronary artery disease; Acute coronary syndrome; Clinical decision pathway

DOI：

10.7507/1002-0179.202111055

Video：

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Abstract Full text Figures/Tables Video References Cited by

The American Heart Association and other six major associations jointly released AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain for the first report on October 28th, 2021. This guideline stresses the risk stratification and the diagnostic workup of acute chest pain, considers the cost-effectiveness of low-risk chest pain diagnosis and examination, and recommends sharing decisions with patients. This guideline mainly involves the initial evaluation of chest pain, choosing the right pathway with patient-centric algorithms for acute chest pain, and the evaluation of patients with stable chest pain. This review makes a detailed interpretation of the recommended points of the guideline through reviewing the literature.

Citation： LI Dongze, LIU Bofu, ZHOU Fating, JIAN Mengyao, WANG Zhiyuan, XIANG Xinjie, TANG Songling, MA Wen, JIA Yu, CAO Yu. Interpretation of 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. West China Medical Journal, 2021, 36(11): 1488-1496. doi: 10.7507/1002-0179.202111055 Copy

1.	Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021: Cir0000000000001029.
2.	Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021: Cir0000000000001030.
3.	Hsia RY, Hale Z, Tabas JA. A national study of the prevalence of life-threatening diagnoses in patients with chest pain. JAMA Intern Med, 2016, 176(7): 1029-1032.
4.	Lindsell CJ, Anantharaman V, Diercks D, et al. The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): a multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. Ann Emerg Med, 2006, 48(6): 666-677, 677. e1-677. e9.
5.	Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 130(25): e344-426.
6.	Meisel ZF, Armstrong K, Mechem CC, et al. Influence of sex on the out-of-hospital management of chest pain. Acad Emerg Med, 2010, 17(1): 80-87.
7.	Grosmaitre P, Le Vavasseur O, Yachouh E, et al. Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments. Arch Cardiovasc Dis, 2013, 106(11): 586-592.
8.	Graham G. Racial and ethnic differences in acute coronary syndrome and myocardial infarction within the United States: from demographics to outcomes. Clin Cardiol, 2016, 39(5): 299-306.
9.	Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation, 2018, 138(1): e1-e34.
10.	Ohle R, Um J, Anjum O, et al. High risk clinical features for acute aortic dissection: a case-control study. Acad Emerg Med, 2018, 25(4): 378-387.
11.	Diercks DB, Kontos MC, Chen AY, et al. Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol, 2009, 53(2): 161-166.
12.	Apple FS, Jesse RL, Newby LK, et al. National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: analytical issues for biochemical markers of acute coronary syndromes. Circulation, 2007, 115(13): e352-e355.
13.	Morrow DA, Cannon CP, Jesse RL, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation, 2007, 115(13): e356-e375.
14.	Chapman AR, Anand A, Boeddinghaus J, et al. Comparison of the efficacy and safety of early rule-out pathways for acute myocardial infarction. Circulation, 2017, 135(17): 1586-1596.
15.	Twerenbold R, Wildi K, Jaeger C, et al. Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction. Circulation, 2015, 131(23): 2041-2050.
16.	Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes, 2015, 8(2): 195-203.
17.	Than MP, Pickering JW, Aldous SJ, et al. Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice. Ann Emerg Med, 2016, 68(1): 93-102.e101.
18.	Stopyra JP, Miller CD, Hiestand BC, et al. Validation of the no objective testing rule and comparison to the HEART Pathway. Acad Emerg Med, 2017, 24(9): 1165-1168.
19.	Twerenbold R, Costabel JP, Nestelberger T, et al. Outcome of applying the ESC 0/1-hour algorithm in patients with suspected myocardial infarction. J Am Coll Cardiol, 2019, 74(4): 483-494.
20.	Collet JP, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J, 2021, 42(14): 1289-1367.
21.	Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J, 2016, 37(3): 267-315.
22.	Bandstein N, Ljung R, Johansson M, et al. Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol, 2014, 63(23): 2569-2578.
23.	Neumann JT, Twerenbold R, Ojeda F, et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med, 2019, 380(26): 2529-2540.
24.	Mahler SA, Lenoir KM, Wells BJ, et al. Safely identifying emergency department patients with acute chest pain for early discharge. Circulation, 2018, 138(22): 2456-2468.
25.	Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation, 2008, 117(10): 1283-1291.
26.	Boden WE, O’Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med, 1998, 338(25): 1785-1792.
27.	Puchner SB, Liu T, Mayrhofer T, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-Ⅱ trial. J Am Coll Cardiol, 2014, 64(7): 684-692.
28.	Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol, 2015, 66(4): 337-346.
29.	Chang HJ, Lin FY, Lee SE, et al. Coronary atherosclerotic precursors of acute coronary syndromes. J Am Coll Cardiol, 2018, 71(22): 2511-2522.
30.	Chinnaiyan KM, Safian RD, Gallagher ML, et al. Clinical use of CT-derived fractional flow reserve in the emergency department. JACC Cardiovasc Imaging, 2020, 13(2 Pt 1): 452-461.
31.	Pasupathy S, Air T, Dreyer RP, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation, 2015, 131(10): 861-870.
32.	Dastidar AG, Rodrigues JC, Ahmed N, et al. The role of cardiac MRI in patients with troponin-positive chest pain and unobstructed coronary arteries. Curr Cardiovasc Imaging Rep, 2015, 8(8): 28.
33.	Pathik B, Raman B, Mohd Amin NH, et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging, 2016, 17(10): 1146-1152.
34.	Dastidar AG, Rodrigues JCL, Johnson TW, et al. Myocardial infarction with nonobstructed coronary arteries: impact of CMR early after presentation. JACC Cardiovasc Imaging, 2017, 10(10 Pt A): 1204-1206.
35.	Assomull RG, Lyne JC, Keenan N, et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur Heart J, 2007, 28(10): 1242-1249.
36.	Tornvall P, Gerbaud E, Behaghel A, et al. Myocarditis or “true” infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: a meta-analysis of individual patient data. Atherosclerosis, 2015, 241(1): 87-91.
37.	Barbero U, Iannaccone M, d’Ascenzo F, et al. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: a meta-analysis. Int J Cardiol, 2016, 216: 52-57.
38.	Finkel JB, Marhefka GD. Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc, 2011, 86(12): 1198-1207.
39.	DeFilippis EM, Singh A, Divakaran S, et al. Cocaine and marijuana use among young adults with myocardial infarction. J Am Coll Cardiol, 2018, 71(22): 2540-2551.
40.	Zhang Q, Liu Y, Li D, et al. Exercise intervention for the risk of falls in older adults: a protocol for systematic review and meta-analysis. Medicine (Baltimore), 2021, 100(5): e24548.
41.	Drake RE, Deegan PE. Shared decision making is an ethical imperative. Psychiatr Serv, 2009, 60(8): 1007.
42.	Hess EP, Knoedler MA, Shah ND, et al. The chest pain choice decision aid: a randomized trial. Circ Cardiovasc Qual Outcomes, 2012, 5(3): 251-259.
43.	Hess EP, Hollander JE, Schaffer JT, et al. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial. Bmj, 2016, 355: i6165.
44.	Hess EP. Clinical judgment is not passé when it comes to identifying patients with acute myocardial infarction. Evid Based Med, 2016, 21(3): 117.
45.	Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr, 2010, 23(12): 1225-1230.
46.	Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr, 2011, 24(3): 229-267.
47.	Sicari R, Nihoyannopoulos P, Evangelista A, et al. Stress echocardiography expert consensus statement-executive summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J, 2009, 30(3): 278-289.
48.	Medical Advisory Secretariat. Stress echocardiography for the diagnosis of coronary artery disease: an evidence-based analysis. Ont Health Technol Assess Ser, 2010, 10(9): 1-61.
49.	Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr, 2013, 26(9): 965-1012.e15.
50.	Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). G Ital Cardiol (Rome), 2015, 16(12): 702-738.
51.	Hammer MM, Raptis CA, Javidan-Nejad C, et al. Accuracy of computed tomography findings in acute pericarditis. Acta Radiol, 2014, 55(10): 1197-1202.
52.	Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol, 2018, 72(24): 3158-3176.
53.	Taylor AM, Dymarkowski S, Verbeken EK, et al. Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results. Eur Radiol, 2006, 16(3): 569-574.
54.	Young PM, Glockner JF, Williamson EE, et al. MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging, 2012, 28(5): 1099-1109.
55.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
56.	Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network. J Fam Pract, 1994, 38(4): 345-352.
57.	Burgstaller JM, Jenni BF, Steurer J, et al. Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis. PLoS One, 2014, 9(8): e104722.
58.	Kisely SR, Campbell LA, Yelland MJ, et al. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev, 2012(6): Cd004101.
59.	Budoff MJ, Mayrhofer T, Ferencik M, et al. Prognostic value of coronary artery calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation, 2017, 136(21): 1993-2005.
60.	Lubbers M, Dedic A, Coenen A, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. Eur Heart J, 2016, 37(15): 1232-1243.
61.	Shaw LJ, Mieres JH, Hendel RH, et al. Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation, 2011, 124(11): 1239-1249.
62.	Newby DE, Adamson PD, Berry C, et al. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med, 2018, 379(10): 924-933.
63.	Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol, 2008, 52(25): 2135-2144.
64.	Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med, 2015, 372(14): 1291-1300.
65.	Marwick TH, Case C, Vasey C, et al. Prediction of mortality by exercise echocardiography: a strategy for combination with the duke treadmill score. Circulation, 2001, 103(21): 2566-2571.
66.	Rozanski A, Gransar H, Min JK, et al. Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors. J Nucl Cardiol, 2014, 21(2): 341-350.
67.	Dorbala S, Di Carli MF, Beanlands RS, et al. Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol, 2013, 61(2): 176-184.
68.	Kay J, Dorbala S, Goyal A, et al. Influence of sex on risk stratification with stress myocardial perfusion Rb-82 positron emission tomography: results from the PET (Positron Emission Tomography) Prognosis Multicenter Registry. J Am Coll Cardiol, 2013, 62(20): 1866-1876.
69.	Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2012, 60(24): e44-e164.
70.	Gibbons RJ, Carryer D, Liu H, et al. Use of echocardiography in outpatients with chest pain and normal resting electrocardiograms referred to Mayo Clinic Rochester. Am Heart J, 2018, 196: 49-55.
71.	Fairbairn TA, Nieman K, Akasaka T, et al. Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry. Eur Heart J, 2018, 39(41): 3701-3711.
72.	Rabbat M, Leipsic J, Bax J, et al. Fractional flow reserve derived from coronary computed tomography angiography safely defers invasive coronary angiography in patients with stable coronary artery disease. J Clin Med, 2020, 9(2): 604.
73.	Abidov A, Gallagher MJ, Chinnaiyan KM, et al. Clinical effectiveness of coronary computed tomographic angiography in the triage of patients to cardiac catheterization and revascularization after inconclusive stress testing: results of a 2-year prospective trial. J Nucl Cardiol, 2009, 16(5): 701-713.
74.	Schepis T, Gaemperli O, Koepfli P, et al. Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med, 2007, 48(9): 1424-1430.
75.	Blankstein R, Di Carli MF. Integration of coronary anatomy and myocardial perfusion imaging. Nat Rev Cardiol, 2010, 7(4): 226-236.

1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021: Cir0000000000001029.
2. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021: Cir0000000000001030.
3. Hsia RY, Hale Z, Tabas JA. A national study of the prevalence of life-threatening diagnoses in patients with chest pain. JAMA Intern Med, 2016, 176(7): 1029-1032.
4. Lindsell CJ, Anantharaman V, Diercks D, et al. The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): a multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. Ann Emerg Med, 2006, 48(6): 666-677, 677. e1-677. e9.
5. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 130(25): e344-426.
6. Meisel ZF, Armstrong K, Mechem CC, et al. Influence of sex on the out-of-hospital management of chest pain. Acad Emerg Med, 2010, 17(1): 80-87.
7. Grosmaitre P, Le Vavasseur O, Yachouh E, et al. Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments. Arch Cardiovasc Dis, 2013, 106(11): 586-592.
8. Graham G. Racial and ethnic differences in acute coronary syndrome and myocardial infarction within the United States: from demographics to outcomes. Clin Cardiol, 2016, 39(5): 299-306.
9. Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation, 2018, 138(1): e1-e34.
10. Ohle R, Um J, Anjum O, et al. High risk clinical features for acute aortic dissection: a case-control study. Acad Emerg Med, 2018, 25(4): 378-387.
11. Diercks DB, Kontos MC, Chen AY, et al. Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol, 2009, 53(2): 161-166.
12. Apple FS, Jesse RL, Newby LK, et al. National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: analytical issues for biochemical markers of acute coronary syndromes. Circulation, 2007, 115(13): e352-e355.
13. Morrow DA, Cannon CP, Jesse RL, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation, 2007, 115(13): e356-e375.
14. Chapman AR, Anand A, Boeddinghaus J, et al. Comparison of the efficacy and safety of early rule-out pathways for acute myocardial infarction. Circulation, 2017, 135(17): 1586-1596.
15. Twerenbold R, Wildi K, Jaeger C, et al. Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction. Circulation, 2015, 131(23): 2041-2050.
16. Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes, 2015, 8(2): 195-203.
17. Than MP, Pickering JW, Aldous SJ, et al. Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice. Ann Emerg Med, 2016, 68(1): 93-102.e101.
18. Stopyra JP, Miller CD, Hiestand BC, et al. Validation of the no objective testing rule and comparison to the HEART Pathway. Acad Emerg Med, 2017, 24(9): 1165-1168.
19. Twerenbold R, Costabel JP, Nestelberger T, et al. Outcome of applying the ESC 0/1-hour algorithm in patients with suspected myocardial infarction. J Am Coll Cardiol, 2019, 74(4): 483-494.
20. Collet JP, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J, 2021, 42(14): 1289-1367.
21. Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J, 2016, 37(3): 267-315.
22. Bandstein N, Ljung R, Johansson M, et al. Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol, 2014, 63(23): 2569-2578.
23. Neumann JT, Twerenbold R, Ojeda F, et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med, 2019, 380(26): 2529-2540.
24. Mahler SA, Lenoir KM, Wells BJ, et al. Safely identifying emergency department patients with acute chest pain for early discharge. Circulation, 2018, 138(22): 2456-2468.
25. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation, 2008, 117(10): 1283-1291.
26. Boden WE, O’Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med, 1998, 338(25): 1785-1792.
27. Puchner SB, Liu T, Mayrhofer T, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-Ⅱ trial. J Am Coll Cardiol, 2014, 64(7): 684-692.
28. Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol, 2015, 66(4): 337-346.
29. Chang HJ, Lin FY, Lee SE, et al. Coronary atherosclerotic precursors of acute coronary syndromes. J Am Coll Cardiol, 2018, 71(22): 2511-2522.
30. Chinnaiyan KM, Safian RD, Gallagher ML, et al. Clinical use of CT-derived fractional flow reserve in the emergency department. JACC Cardiovasc Imaging, 2020, 13(2 Pt 1): 452-461.
31. Pasupathy S, Air T, Dreyer RP, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation, 2015, 131(10): 861-870.
32. Dastidar AG, Rodrigues JC, Ahmed N, et al. The role of cardiac MRI in patients with troponin-positive chest pain and unobstructed coronary arteries. Curr Cardiovasc Imaging Rep, 2015, 8(8): 28.
33. Pathik B, Raman B, Mohd Amin NH, et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging, 2016, 17(10): 1146-1152.
34. Dastidar AG, Rodrigues JCL, Johnson TW, et al. Myocardial infarction with nonobstructed coronary arteries: impact of CMR early after presentation. JACC Cardiovasc Imaging, 2017, 10(10 Pt A): 1204-1206.
35. Assomull RG, Lyne JC, Keenan N, et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur Heart J, 2007, 28(10): 1242-1249.
36. Tornvall P, Gerbaud E, Behaghel A, et al. Myocarditis or “true” infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: a meta-analysis of individual patient data. Atherosclerosis, 2015, 241(1): 87-91.
37. Barbero U, Iannaccone M, d’Ascenzo F, et al. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: a meta-analysis. Int J Cardiol, 2016, 216: 52-57.
38. Finkel JB, Marhefka GD. Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc, 2011, 86(12): 1198-1207.
39. DeFilippis EM, Singh A, Divakaran S, et al. Cocaine and marijuana use among young adults with myocardial infarction. J Am Coll Cardiol, 2018, 71(22): 2540-2551.
40. Zhang Q, Liu Y, Li D, et al. Exercise intervention for the risk of falls in older adults: a protocol for systematic review and meta-analysis. Medicine (Baltimore), 2021, 100(5): e24548.
41. Drake RE, Deegan PE. Shared decision making is an ethical imperative. Psychiatr Serv, 2009, 60(8): 1007.
42. Hess EP, Knoedler MA, Shah ND, et al. The chest pain choice decision aid: a randomized trial. Circ Cardiovasc Qual Outcomes, 2012, 5(3): 251-259.
43. Hess EP, Hollander JE, Schaffer JT, et al. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial. Bmj, 2016, 355: i6165.
44. Hess EP. Clinical judgment is not passé when it comes to identifying patients with acute myocardial infarction. Evid Based Med, 2016, 21(3): 117.
45. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr, 2010, 23(12): 1225-1230.
46. Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr, 2011, 24(3): 229-267.
47. Sicari R, Nihoyannopoulos P, Evangelista A, et al. Stress echocardiography expert consensus statement-executive summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J, 2009, 30(3): 278-289.
48. Medical Advisory Secretariat. Stress echocardiography for the diagnosis of coronary artery disease: an evidence-based analysis. Ont Health Technol Assess Ser, 2010, 10(9): 1-61.
49. Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr, 2013, 26(9): 965-1012.e15.
50. Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). G Ital Cardiol (Rome), 2015, 16(12): 702-738.
51. Hammer MM, Raptis CA, Javidan-Nejad C, et al. Accuracy of computed tomography findings in acute pericarditis. Acta Radiol, 2014, 55(10): 1197-1202.
52. Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol, 2018, 72(24): 3158-3176.
53. Taylor AM, Dymarkowski S, Verbeken EK, et al. Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results. Eur Radiol, 2006, 16(3): 569-574.
54. Young PM, Glockner JF, Williamson EE, et al. MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging, 2012, 28(5): 1099-1109.
55. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
56. Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network. J Fam Pract, 1994, 38(4): 345-352.
57. Burgstaller JM, Jenni BF, Steurer J, et al. Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis. PLoS One, 2014, 9(8): e104722.
58. Kisely SR, Campbell LA, Yelland MJ, et al. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev, 2012(6): Cd004101.
59. Budoff MJ, Mayrhofer T, Ferencik M, et al. Prognostic value of coronary artery calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation, 2017, 136(21): 1993-2005.
60. Lubbers M, Dedic A, Coenen A, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. Eur Heart J, 2016, 37(15): 1232-1243.
61. Shaw LJ, Mieres JH, Hendel RH, et al. Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation, 2011, 124(11): 1239-1249.
62. Newby DE, Adamson PD, Berry C, et al. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med, 2018, 379(10): 924-933.
63. Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol, 2008, 52(25): 2135-2144.
64. Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med, 2015, 372(14): 1291-1300.
65. Marwick TH, Case C, Vasey C, et al. Prediction of mortality by exercise echocardiography: a strategy for combination with the duke treadmill score. Circulation, 2001, 103(21): 2566-2571.
66. Rozanski A, Gransar H, Min JK, et al. Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors. J Nucl Cardiol, 2014, 21(2): 341-350.
67. Dorbala S, Di Carli MF, Beanlands RS, et al. Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol, 2013, 61(2): 176-184.
68. Kay J, Dorbala S, Goyal A, et al. Influence of sex on risk stratification with stress myocardial perfusion Rb-82 positron emission tomography: results from the PET (Positron Emission Tomography) Prognosis Multicenter Registry. J Am Coll Cardiol, 2013, 62(20): 1866-1876.
69. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2012, 60(24): e44-e164.
70. Gibbons RJ, Carryer D, Liu H, et al. Use of echocardiography in outpatients with chest pain and normal resting electrocardiograms referred to Mayo Clinic Rochester. Am Heart J, 2018, 196: 49-55.
71. Fairbairn TA, Nieman K, Akasaka T, et al. Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry. Eur Heart J, 2018, 39(41): 3701-3711.
72. Rabbat M, Leipsic J, Bax J, et al. Fractional flow reserve derived from coronary computed tomography angiography safely defers invasive coronary angiography in patients with stable coronary artery disease. J Clin Med, 2020, 9(2): 604.
73. Abidov A, Gallagher MJ, Chinnaiyan KM, et al. Clinical effectiveness of coronary computed tomographic angiography in the triage of patients to cardiac catheterization and revascularization after inconclusive stress testing: results of a 2-year prospective trial. J Nucl Cardiol, 2009, 16(5): 701-713.
74. Schepis T, Gaemperli O, Koepfli P, et al. Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med, 2007, 48(9): 1424-1430.
75. Blankstein R, Di Carli MF. Integration of coronary anatomy and myocardial perfusion imaging. Nat Rev Cardiol, 2010, 7(4): 226-236.

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Interpretation of 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain

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