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November 30, 2021 Circulation. 2021;144:e368–e454. DOI: 10.1161/CIR.0000000000001029 e432

CLINICAL STATEMENTS AND GUIDELINES acute chest pain: subgroup analysis of the ROMICAT II trial. J Cardiovasc Comput Tomogr. 2019;13:196–202. 18.	 Udelson JE, Beshansky JR, Ballin DS, et al. Myocardial perfusion imaging

for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial. JAMA. 2002;288:2693–2700. 19.	 Nucifora G, Badano LP, Sarraf-Zadegan N, et al. Comparison of early dobutamine stress echocardiography and exercise electrocardiographic testing for management of patients presenting to the emergency department with chest pain. Am J Cardiol. 2007;100:1068–1073. 20.	 Linde JJ, Kofoed KF, Sorgaard M, et al. Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain: results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH) Int J Cardiol. 2013;168:5257–5262. 21.	 Blankstein R, Ahmed W, Bamberg F, et al. Comparison of exercise treadmill testing with cardiac computed tomography angiography among patients presenting to the emergency room with chest pain: the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) study. Circ Cardiovasc Imaging. 2012;5:233–242. 22.	 Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–1291. 23.	 Boden WE, O'Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998;338:1785–1792. 24.	 Lee SE, Chang HJ, Sung JM, et al. Effects of statins on coronary atherosclerotic plaques: the PARADIGM study. J Am Coll Cardiol Img. 2018;11:1475–1484. 25.	 Sand NPR, Veien KT, Nielsen SS, et al. Prospective comparison of FFR derived from coronary ct angiography with SPECT perfusion imaging in stable coronary artery disease: the ReASSESS study. J Am Coll Cardiol Img. 2018;11:1640–1650. 26.	 Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/

PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354–e471.

4.1.3 High-Risk Patients With Acute Chest Pain

1 Mahmarian JJ, Shaw LJ, Filipchuk NG, et al. A multinational study to es-

tablish the value of early adenosine technetium-99m sestamibi myocardial perfusion imaging in identifying a low-risk group for early hospital discharge after acute myocardial infarction. J Am Coll Cardiol. 2006;48:2448–2457. 2.	 Mahmarian JJ, Dakik HA, Filipchuk NG, et al. An initial strategy of intensive medical therapy is comparable to that of coronary revascularization for suppression of scintigraphic ischemia in high-risk but stable survivors of acute myocardial infarction. J Am Coll Cardiol. 2006;48:2458–2467. 3.	 Yan AT, Yan RT, Tan M, et al. Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. Eur Heart J. 2007;28:1072–1078. 4.	 Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344–e426. 5.	 Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/ SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69:2212–2241. 6.	 Patel MR, Bailey SR, Bonow RO, et al. ACCF/SCAI/AATS/AHA/ASE/

ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;59:1995–2027. 7.	 Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI fo-

cused update on primary percutaneous coronary intervention for patients with STelevation myocardial infarction: an update of the 2011 ACCF/ AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-Elevation myocardial infarction. Circulation. 2016;133:1135–1147. 8.	 Pathik B, Raman B, Mohd Amin NH, et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1146–1152. 9.	 Dastidar AG, Rodrigues JCL, Johnson TW, et al. Myocardial infarction with nonobstructed coronary arteries: impact of CMR early after presentation. J Am Coll Cardiol Img. 2017;10:1204–1206. 10.	 Assomull RG, Lyne JC, Keenan N, et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur Heart J. 2007;28:1242–1249. 11.	 Tornvall P, Gerbaud E, Behaghel A, et al. Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: a meta-analysis of individual patient data. Atherosclerosis. 2015;241:87–91. 12.	 Dastidar AG, Baritussio A, De Garate E, et al. Prognostic role of CMR and conventional risk factors in myocardial infarction with nonobstructed coronary arteries. J Am Coll Cardiol Img. 2019;12:1973–1982. 13.	 Greenslade JH, Carlton EW, Van Hise C, et al. Diagnostic accuracy of a new high-sensitivity troponin I assay and five accelerated diagnostic pathways for ruling out acute myocardial infarction and acute coronary syndrome. Ann Emerg Med. 2018;71:439–451, e3. 14.	 Raff GL, Hoffmann U, Udelson JE. Trials of imaging use in the emergency department for acute chest pain. J Am Coll Cardiol Img. 2017;10:338–349. 15.	 Cohen M. High-risk acute coronary syndrome patients with non-ST-elevation myocardial infarction: definition and treatment. Cardiovasc Drugs Ther. 2008;22:407–418. 16.	 Steg PG, FitzGerald G, Fox KA. Risk stratification in non-ST-segment elevation acute coronary syndromes: troponin alone is not enough. Am J Med. 2009;122:107–108. 17.	 Pasupathy S, Air T, Dreyer RP, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861–870. 18.	 Dastidar AG, Rodrigues JC, Ahmed N, et al. The role of cardiac MRI in patients with troponin-positive chest pain and unobstructed coronary arteries. Curr Cardiovasc Imaging Rep. 2015;8:28. 19.	 Niccoli G, Scalone G, Crea F. Acute myocardial infarction with no obstruc-

tive coronary atherosclerosis: mechanisms and management. Eur Heart J. 2015;36:475–481.

4.1.4 Acute Chest Pain in Patients With Prior Coronary Artery Bypass Graft (CABG) Surgery

1 Fitzgibbon GM, Kafka HP, Leach AJ, et al. Coronary bypass graft fate and

patient outcome: angiographic follow-up of 5 065 grafts related to survival and reoperation in 1 388 patients during 25 years. J Am Coll Cardiol. 1996;28:616–626. 2.	 Harskamp RE, Lopes RD, Baisden CE, et al. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg. 2013;257:824–833. 3.	 Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ASE/ASNC/HFSA/ HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;63:380–406. 4.	 Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/

ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiol-

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