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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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[1]
Recommendations for Patients With Obstructive Coronary Artery Disease Who Present With Stable Chest Pain
Anatomic Testing
| Class I |
| 1.For patients with obstructive CAD who have stable chest pain despite GDMT and moderate- severe ischemia, ICA is recommended for guiding therapeutic decision-making.1 (Level of Evidence: A) |
| 2.For patients with obstructive CAD who have stable chest pain despite optimal GDMT, those referred for ICA without prior stress testing benefit from FFR or instantaneous wave free ratio. (Level of Evidence: A) |
| 3.For symptomatic patients with obstructive CAD who have stable chest pain with CCTA- defined ≥50% stenosis in the left main coronary artery, obstructive CAD with FFR with CT ≤0.80, or severe stenosis (≥70%) in all 3 main vessels, ICA is effective for guiding therapeutic decision-making (Level of Evidence: B-R) |
| Class IIa |
| 1.For patients who have stable chest pain with previous coronary revascularization, CCTA is reasonable to evaluate bypass graft or stent patency (for stents ≥3 mm). (Level of Evidence: B-NR) |
Stress Testing
| Class I |
| 1.For patients with obstructive CAD who have stable chest pain despite optimal GDMT, stress PET/SPECT MPI, CMR, or echocardiography is recommended for diagnosis of myocardial ischemia, estimating risk of MACE, and guiding therapeutic decision-making. (Level of Evidence: B-NR) |
| Class IIa |
| 1.In patients with chest pain and intermediate to-high clinical suspicion for ACS in whom the initial ECG is non-diagnostic, supplemental electrocardiographic leads V7 to V9 are reasonable to rule out posterior MI (Level of Evidence: B-NR) |
| 2. For patients with obstructive CAD who have stable chest pain despite optimal GDMT, when selected for rest/stress nuclear MPI, PET is reasonable in preference to SPECT, if available, to improve diagnostic accuracy and decrease the rate of non-diagnostic test results. (Level of Evidence: B-R) |
| 3. For patients with obstructive CAD who have stable chest pain despite GDMT, exercise treadmill testing can be useful to determine if the symptoms are consistent with angina pectoris, assess the severity of symptoms, evaluate functional capacity and select management, including cardiac rehabilitation. (Level of Evidence: B-NR) |
| 4. For patients with obstructive CAD who have stable chest pain symptoms undergoing stress PET MPI or stress CMR, the addition of MBFR is useful to improve diagnosis accuracy and enhance risk stratification. (Level of Evidence: B-NR) |
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [2]
Electrophysiological Testing in Patients With Coronary Heart Disease
| Class I |
| "1. EP testing is recommended for diagnostic evaluation of patients with remote MI with symptoms suggestive of ventricular tachyarrhythmias, including palpitations, presyncope, and syncope. (Level of Evidence: B)" |
| "2. EP testing is recommended in patients with CHD to guide and assess the efficacy of VT ablation. (Level of Evidence: B)" |
| "3. EP testing is useful in patients with CHD for the diagnostic evaluation of wide-QRS-complex tachycardias of unclear mechanism. (Level of Evidence: C)" |
| Class IIa |
| "1. EP testing is reasonable for risk stratification in patients with remote MI, NSVT, and LVEF equal to or less than 40%. (Level of Evidence: B)" |
References
- ↑ Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK; et al. (2021). "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. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check
|pmid=value (help). - ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.