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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES & RELATED

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Monday, March 14, 2022

2021 AHA Chest Pain

First 10EM - By Justin Morgenstern - March 14, 2022
The paper: "Writing Committee Members, 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. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-e285. doi: 10.1016/j.jacc.2021.07.053. Epub 2021 Oct 28. PMID: 34756653 [free full text]

Some of my key take-aways
This is a very long and dense publication. The majority of their recommendations are not practice changing (things like calling 911 if you have chest pain, or trying to get an ECG done within 10 minutes) and there is a lot that is irrelevant to emergency physicians. I am not going to attempt a comprehensive summary of the guidelines. Some people will want to read them all, and they are available for free online. I am just going to highlight a few points that I found interesting, potentially practice changing, or clearly wrong.
  • No stress tests in low risk patients
  • High sensitivity troponin is preferred
  • They like echo in intermediate risk patients
  • They are stuck in the STEMI/NSTEMI world
  • Share the decision making
  • Forget “atypical”
  • Their text sometimes doesn’t match their recommendations: Should you get a chest x-ray?
  • They really like structured risk assessment and clinical decision pathways
  • They give you a warranty period based on prior test results (which I don’t think is at all evidence based)