Am Fam Physician. 2023;107(2):204-206
Author disclosure: No relevant financial relationships.
Key Points for Practice
• Attempt to perform 12-lead ECG in patients with chest pain within 10 minutes of arrival to a clinic or emergency setting.
• Use a clinical decision pathway to identify patients with low-risk chest pain who can be discharged from the emergency department.
• If available, use CCTA preferentially over stress testing for patients with intermediate-risk chest pain to determine the need for invasive coronary angiography. For patients with high-risk chest pain, provide referral for invasive coronary angiography.
• In patients with known CAD, focus on controlling blood pressure and cholesterol. Consider CCTA to document CAD progression in patients with previous testing demonstrating nonobstructive lesions.
From the AFP Editors
Chest pain leads to about 4 million outpatient visits per year and is the second most common reason for emergency department care, with nearly 7 million visits per year. Although most chest pain is noncardiac, more than 18 million people in the United States have coronary artery disease (CAD), leading to more than 1,000 deaths per day. The American Heart Association/American College of Cardiology (AHA/ACC) updated guidelines for management of chest pain, which are endorsed by five other cardiology groups. The guidelines provide new recommendations on what to consider chest pain and when to avoid testing in patients at low risk, and they endorse use of published decision pathways to determine the order and extent of workup.
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