Thread by @Heart_SCCT

The NEW @AHAScience @ACCinTouch @ASE360 @accpchest @SAEMonline @Heart_SCCT @SCMRorg Guideline for the Evaluation and Diagnosis of Chest Pain has been released. #CPguideline

jacc.org/doi/10.1016/j.…

Here are highlights for #YesCCT: (1/17)

(2/17) #CCTA receives the highest level of recommendation (1A) in new US #CPGuideline

Guideline sponsored by: @AHAScience @ACCinTouch @ASE360 @accpchest @SAEMonline @Heart_SCCT @SCMRorg

In this CP Guideline Tweetorial the (Level of Recommendation is in parentheses).

(3/17) Acute CP | Intermediate Risk & ⛔known CAD: After ruling out ACS, CCTA is useful to exclude plaque & obstructive CAD as a first line approach (1A) ✅ #CPguideline

(4/17): Stable CP | Intermediate-High Risk and ⛔known CAD: CCTA is effective for the diagnosis of CAD, for risk stratification and for guiding treatment decisions as first line (1A) ✅ #CPguideline

(5/17): Stable CP | CCTA enables exclusion of obstructive CAD and identification of obstructive high risk CAD (left main stenosis  50% or significant  70% 3-vessel stenosis) that guides decision making for invasive coronary angiography (1B) ✅ #CPGuideline

(6/17)Choosing the✅test: Factors that favor CCTA include identification of plaque (to intensify guideline directed medical therapy), age <65, prior inconclusive study & intermediate to⬆️risk in which less obstructive CAD is suspected; In⬇️risk, CAC /no-testing may be preferred.

(7/17): CP Testing and General Considerations: This guideline focuses on selective use of testing, optimization of lower cost, reducing layered testing and eliminating low yield testing specific CCTA scenarios follow in the remainder of the Tweetorial. #CPguideline

(8/17): Acute CP | Intermediate Risk w prior mildly abnormal stress test OR inconclusive prior stress test: CCTA is reasonable to diagnose obstructive CAD (2a). #CPGuideline

(9/17): Acute CP | Intermediate risk, ⛔prior CAD & 40-90% stenosis in proximal or mid vessel: FFR-CT is useful for diagnosis of ischemia and to guide decision-making for goal directed medical therapy vs revascularization (2a). #CPGuideline

(10/17): Acute CP, Known Non-obs CAD & Intermediate Risk | CCTA can be useful to determine progression of plaque (incl. prior #CAC), obs CAD (2a) + facilitate d/c. FFR-CT is reasonable for 40-90% stenosis in proximal or mid vessel to guide GDMT v revascularization (2a).

(11/17): Stable CP | Low-risk, ⛔ known CAD: In low-risk, #CAC is reasonable as a first line-test to exclude plaque (2a). #CACZero identifies a low-risk cohort of patients who may not require additional testing. #CPGuideline

(12/17): Stable CP | Intermediate-High Risk with CCTA 40-90% stenosis in proximal or mid segment: FFR-CT is useful for diagnosis of ischemia and to guide decision-making for goal directed medical therapy vs revascularization (2a). #CPGuideline

(13/17): Stable CP | Intermediate-High Risk after inconclusive stress test: CCTA is reasonable (2a); CAC testing can also be useful (2a). After negative stress test but high suspicion of CAD, CCTA (or cath) may be reasonable. #CPGuideline

(14/17): Stable CP Known CAD and persistent symptoms: Progression of CAD (new stenosis, significant ischemia by FFR-CT or more extensive non-obstructive plaque) may be characterized using CCTA (2a). #CPGuideline

(15/17): Stable CP and Pre-Test Probability: The new US #CPGuideline articulates pre-test probabilities according to age, sex and symptoms as well as with age, sex, symptoms and #CAC. Darker green and orange denote areas in which testing is most beneficial.

(16/17) Learn more about this new #CPGuideline at scct.org/page/ChestPain….

(17/17) SCCT congratulates and thanks the #CPGuideline Writing Committee!

Chairs: @DrMarthaGulati
Phillip D. Levy, MD, MPH
Debabrata Mukherjee, MD, MS

SCCT Representative: @RonBlankstein