Disease Prevention

Updated Standards on Chest Pain Diagnosis and Evaluation

Jessica Ganga
09/06/2022

The American College of Cardiology (ACC) and the American Heart Association (AHA) has released an update to the 2021 guideline for evaluating and diagnosing chest pain, which now includes standardized definitions of various chest pains to improve the prevention and treatment of cardiovascular diseases in these patients.

The 2021 guidelines1 recommended that the terms “cardiac,” “possible cardiac,” and “noncardiac” be used to describe chest pain symptoms rather than “typical” or “atypical” as they avoid potential issues of ambiguity when diagnosing a patient. The latest guidelines2 further expand upon these changes, dividing data elements into 3 categories: chest pain, myocardial injury, and myocardial infarction. Furthermore, risk scores should be used within the clinical context of each patient presented, which is aligned with the previous guidelines.

Also included among the new recommendations:

  • The authors found a need for a uniform definition of myocardial infarction to accurately report data across clinical trials and registries.
  • The guidelines suggest that clinicians must distinguish between one of the myocardial subtypes and nonischemic myocardial injury, as acute myocardial injury is related to the diagnosis of myocardial injury.
  • A reference chart for clinicians including the data elements and their definitions, permissible values and their definitions, and the source of the definitions for each chest pain category.

“Chest pain is the second most common reason for adults to present to an emergency department in the United States, accounting for [more than] 7 million visits annually,” the authors wrote. “Although noncardiac causes of chest pain account for a large majority of these cases, there are several dangerous and life-threatening causes of chest pain that must be identified and treated promptly. Distinguishing between serious and nonserious causes of chest pain is an urgent imperative.”

Reference:

1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC 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;78(22):e187–e285. Accessed September 9, 2022. doi:10.1016/j.jacc.2021.07.053.

2. Anderson HV, Masri SC, Abdallah MS, et al. 2022 ACC/AHA key data elements and definitions for chest pain and acute myocardial infarction: a report of the American Heart Association/American College of Cardiology joint committee on clinical data standards. J Am Coll Cardiol. Published online August 30, 2022. doi:10.1016/j.jacc.2022.05.012