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

Gulati, Martha; Levy, Phillip D.; Mukherjee, Debabrata; Amsterdam, Ezra A.; Bhatt, Deepak L.; Birtcher, Kim K.; Blankstein, Ron; Boyd, Jack; Bullock-Palmer, Renée P.; Conejo, Theresa; Diercks, Deborah B.; Gentile, Federico; Greenwood, John P; Hess, Erik P.; Hollenberg, Steven M.; Jaber, Wael A.; Jneid, Hani; Joglar, José A.; Morrow, David A.; O’Connor, Robert E.; Ross, Michael A.; Shaw, Leslee J.

doi:10.1161/cir.0000000000001029

Cited by 632 publications

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“…Diagnostic and treatment guidelines serve several important purposes with an overall aim to improve medical care. The 2021 American Heart Association (AHA)/American College of Cardiology (ACC) Chest Pain Guidelines [ 1 , 2 ] represent a dramatic evolution from the prior 2012 ACC/AHA Chest Pain Guidelines [ 3 ]. For the practitioner that uses or performs cardiovascular magnetic resonance (CMR), the release of new guidelines is an opportunity to reassess what we do, how we do it, and how CMR should be used relative to other imaging modalities.…”

Section: Society For Cardiovascular Magnetic Resonance Perspective On the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…The 2021 AHA/ACC Chest Pain Guidelines include many recommendations for the use of CMR which are briefly summarized in the next paragraphs and figures. This summary does not include non-CMR recommendations as the full guidelines are published in the Journal of the American College of Cardiology [ 1 ] and Circulation [ 2 ]. They are also planned to be published later this year in the Journal of Cardiovascular Magnetic Resonance .…”

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…

Fig. 1 Acute Chest Pain Recommendations for CMR [ 1 , 2 ]. CAD coronary artery disease, CCTA coronary artery computed tomography angiography, CMR cardiovascular magnetic resonance, ECG electrocardiogram, ICA invasive coronary angiography, MPI myocardial perfusion imaging, PET positron emission tomography, SPECT single photon emission computed tomography …”

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…

Fig. 2 Other Scenarios for Acute Chest Pain—Recommendations for CMR [ 1 , 2 ]. CT computed tomography, MINOCA myocardial infarction with no obstructive coronary arteries, TEE transesophageal echocardiography, TTE transthoracic echocardiography, VHD valvular heart disease.…”

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…

Fig. 3 Stable Chest Pain Guidelines for CMR [ 1 , 2 ]. INOCA, ischemia with no obstructive coronary arteries; MACE , major adverse cardiovascular event; MBFR , myocardial blood flow reserve.…”

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

See 4 more Smart Citations

Society forÂ CardiovascularÂ MagneticÂ Resonance perspective on the 2021 AHA/ACC Chest Pain Guidelines

Arai¹,

Kwong

Salerno

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Section: Society For Cardiovascular Magnetic Resonance Perspective On the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

“…

Fig. 3 Stable Chest Pain Guidelines for CMR [ 1 , 2 ]. INOCA, ischemia with no obstructive coronary arteries; MACE , major adverse cardiovascular event; MBFR , myocardial blood flow reserve.…”

Section: Indications For Cmr In the 2021 Aha/acc Chest Pain Guidelinesmentioning

confidence: 99%

See 3 more Smart Citations

Society forÂ CardiovascularÂ MagneticÂ Resonance perspective on the 2021 AHA/ACC Chest Pain Guidelines

Arai¹,

Kwong

Salerno

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Traditional Chinese Medicine Compound and Clinical Outcomes in Acute Myocardial Infarction

Asham,

Entezari-Maleki

2024

JAMA

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To the Editor The China Tongxinluo Study for Myocardial Protection in Patients With Acute Myocardial Infarction (CTS-AMI) 1 recently showed that the Chinese traditional medicine Tongxinluo significantly improved both 30-day and 1-year clinical outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI). However, we are concerned that patient risk stratification was not included in this study.The 2020 ESC guidelines for the management of acute coronary syndromes and the 2021 AHA/ACC/ASE/CHEST/ SAEM/SCCT/SCMR guidelines for the evaluation and diagnosis of chest pain recommended use of risk stratification to identify best treatment modality and estimate patients' prognostic outcome. A variety of prognostic models have been elucidated with the aim of assessing the risk of all-cause mortality or the combined risk of all-cause mortality or myocardial infarction. 2,3 The Thrombolysis in Myocardial Infarction (TIMI) algorithm was first introduced to calculate risk stratification in patients with acute coronary syndrome. 4 The second most commonly used score is the Global Registry of Acute Coronary Events (GRACE) risk model, which incorporated a more representative community-based registry. The GRACE risk score has been found to be more effective at predicting risk of mortality or myocardial infarction when compared with subjective physician evaluation. 2 Although the CTS-AMI 1 study reported prognostic risk factors of mortality in STEMI, such as age, sex, diabetes, hypertension, and medications (aspirin, angiotensin-converting enzyme inhibitors, statins, and β-blockers), its omission of risk stratification may have affected the study results because these tools are necessary to choose the best STEMI treatment modalities based on the guidelines. 2,3

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The Evolving Landscape of Cardiovascular Risk Assessment

Grant,

Ndumele,

Martin

2024

JAMA

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Cardiovascular disease (CVD) remains the leading cause of death 1 in the US and globally and risk estimation is a cornerstone approach to guiding CVD prevention. Over the past 2 decades, various tools and strategies for predicting future cardiovascular risk have been studied and deployed. The overarching goal is to match the intensity of preventive therapy to absolute risk to have the greatest impact in preventing CVD events. Even small or moderate changes in risk estimation could have a large impact at a population-health level when applied to guidance for preventive therapies.The Framingham Risk Score 2 and its derivatives 3,4 were the earliest US guideline-recommended tools for assessing risk of coronary heart disease to inform primary prevention therapies. The Framingham Risk Score estimated the 10-year risk for angina, myocardial infarction, or death due to coronary heart disease. However, a major limitation included the lack of generalizability to modern populations because the Framingham cohort was composed of homogeneous, geographically limited, predominantly White participants with higher smoking rates and lower use of preventive therapies compared with many contemporary US populations.In 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) developed an atherosclerotic cardiovascular disease (ASCVD) risk score (expanding prediction beyond coronary heart disease to include stroke) known as the pooled cohort equations (PCEs) 5 to predict 10year and lifetime risk of ASCVD. The PCEs were derived from 5 racially and geographically diverse prospective cohort studies (N = 24 626) and used the same traditional risk factors as the original Framingham Risk Score, but additionally offered separate equations for White and Black men and women. The 2013 ACC/AHA Blood Cholesterol Guideline 6 indicated a clear net absolute benefit of moderate-to high-intensity statin therapy at an estimated 10-year ASCVD risk at or above 7.5% based on randomized controlled trial evidence.Although they advanced risk estimation, the PCEs have garnered concern for overestimating cardiovascular risk. A study using the Multi-Ethnic Study of Atherosclerosis 7 demonstrated that the PCEs overestimated ASCVD risk by 86%. Potential reasons for this overestimation include the changing profile of risk factors between historical and modern cohorts, more effective therapies for preventing ASCVD events in the presence of risk factors, the "healthy cohort effect" (ie, cohort participants being healthier than the general population), and incomplete capture of cardiovascular events.Responding to these limitations, the Predicting Risk of cardiovascular disease Events (PREVENT) equations were intro-

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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

Cited by 632 publications

References 630 publications

Society forÂ CardiovascularÂ MagneticÂ Resonance perspective on the 2021 AHA/ACC Chest Pain Guidelines

Society forÂ CardiovascularÂ MagneticÂ Resonance perspective on the 2021 AHA/ACC Chest Pain Guidelines

Traditional Chinese Medicine Compound and Clinical Outcomes in Acute Myocardial Infarction

The Evolving Landscape of Cardiovascular Risk Assessment

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