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

Abstract

Aim: This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain” provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.

Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination

“…According to the 2021 American Heart Association/American College of Cardiology/American Society of Echocardiography/American College of Chest Physicians/Society for Academic Emergency Medicine/Society of Cardiovascular Computed Tomography/Society for Cardiovascular Magnetic Resonance Guideline for the Evaluation and Diagnosis of Chest Pain, cardiac MRI is useful in distinguishing myocarditis from other causes of acute chest pain in patients with myocardial injury who have nonobstructive coronary arteries at anatomic testing. Cardiac MRI is also useful in patients with suspected myocarditis or myopericarditis if there is diagnostic uncertainty or to determine the presence and extent of myocardial or pericardial inflammation and fibrosis ( 22 ).…”

Cardiac MR: From Theory to Practice

“…In contrast, non-ischemic pathologies such as dilated cardiomyopathy or myocarditis tend to be associated with LGE in an epicardial or mid-wall distribution, allowing ischemic and non-ischemic etiologies of heart failure to be readily distinguished ( Figure 4B ). CMR is regarded as a class I indication for evaluating acute chest pain or myocardial injury in patients with unobstructed coronary arteries (level of evidence B: moderate quality evidence from one or more well-designed, well-executed non-randomized studies, observational studies or registry studies or meta-analyses of such studies) ( 69 ). As well as being diagnostically valuable, it is increasingly being recognized that the presence and/or extent or pattern of LGE may have prognostic significance ( 70 – 74 ).…”

“…As mentioned previously, this technique is frequently used in tandem with LGE imaging to assess for myocardial ischemia and viability and thereby determine the need for or to guide revascularization ( 76 ). Recent US chest pain guidelines now regard this as a class I indication for stress CMR (level of evidence B) ( 69 ). Advances in sequence design, image processing, and quantification techniques now enable myocardial blood flow to be measured at the voxel level with high in-plane spatial resolution ( 78 – 83 ).…”

The Role of Antiplatelet Therapy in Patients With MINOCA

“…2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation ( 33 ). 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain ( 52 ). International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management ( 53 ).…”