ACC-AHA 2021 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain

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頁	クラス	推奨文
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p.28	1 A	4. Among patients evaluated in the ED who need further testing, exercise ECG is safe with most patients having negative studies and a low risk of ACS.1,4,10,14-31,54 Stress echocardiography is safe and effective for triage and prompt discharge of patients and is associated with few events among those with normal or low-risk findings over nearterm follow-up of up to 6 months.17,18,36 Prompt stress echocardiography resulted in a reduction in ED and hospital length of stay, compared with CCTA, with similar 2-year MACE rates (P=0.47).29 In the ED evaluation of patients with acute chest pain, a nuclear MPI strategy is similarly safe when compared with CCTA with no difference in MACE (death, ACS, or stroke) over follow-up of 6 to 12 months. Longer-term follow-up data from the PROSPECT trial10 supported that at ∼3.5 years, the rate of MACE was similar between MPI and CCTA (P=0.29).10 Compared with CCTA, use of stress MPI delayed the time to diagnosis by >50%.1,4 Furthermore, recent observation from 213 patients referred for rest-stress MPI with mildly abnormal hs-cTn values reported no adverse events related to the tests and a modest 13.6% yield for ischemic studies.55 Single-center, small (n=105) randomized trial evidence suggests that stress CMR is safe without a near-term (90-day) increase in hospital readmission or additional testing.32-34 From a single-center registry (n=135), stress CMR was associated with a high sensitivity (100%) and specificity (93%) for the detection of obstructive CAD or cardiovascular events at 1 year.35
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p.41	1 A	cardiovascular events.7 Additionally, exercise testing without imaging is also reasonable to perform in low-risk individuals with stable chest pain and no known CAD to exclude myocardial ischemia and assess functional capacity10 (Figure 12). CLINICAL STATEMENTS AND GUIDELINES Recommendation-Specific Supportive Text
p.44	1 A	Downloaded from http://ahajournals.org by on October 7, 2026 Assessment of Left Ventricular Function 6. Clinical practice guidelines and appropriate use criteria support use of TTE as appropriate for the assessment of regional and global left ventricular function.13,14 The likelihood of abnormal findings increases when TTE is performed selectively among higher risk patients, such as those with electrocardiographic Q waves or heart failure symptoms, complex ventricular arrhythmias, or a heart murmur.52 Sequential or Add-on Testing: What to Do if Index Test Results are Positive or Inconclusive
p.45	1 A	CLINICAL STATEMENTS AND GUIDELINES
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