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4.1.3. High-Risk Patients With Acute Chest Pain
COR LOE
Recommendations
1 B-NR 1. For patients with acute chest pain and suspected ACS
who have new ischemic changes on electrocardiography,
troponin-confirmed acute myocardial injury, new-onset left
ventricular systolic dysfunction (ejection fraction <40%),
newly diagnosed moderate-severe ischemia on stress testing,
hemodynamic instability, and/or a high clinical decision
pathway (CDP) risk score should be designated as high risk
for short-term MACE.
1 C-EO 2. For patients with acute chest pain and suspected ACS who are
designated as high risk, ICA is recommended.
2a B-NR 3. For high-risk patients with acute chest pain who are troponin
positive in whom obstructive CAD has been excluded by
CCTA or ICA, CMR or echocardiography can be effective in
establishing alternative diagnoses.
Treatment
4.1.4. Acute Chest Pain in Patients With Prior CABG Surgery
COR LOE
Recommendations
1 C-LD 1. In patients with prior CABG surgery presenting with acute
chest pain who do not have ACS, performing stress imaging
is effective to evaluate for myocardial ischemia or CCTA for
graft stenosis or occlusion.
1 C-LD 2. In patients with prior CABG surgery presenting with
acute chest pain, who do not have ACS or who have an
indeterminate/nondiagnostic stress test, ICA is useful.
4.1.5. Evaluation of Patients With Acute Chest Pain Receiving
Dialysis
COR LOE
Recommendation
1 B-NR 1. In patients who experience acute unremitting chest pain while
undergoing dialysis, transfer by EMS to an acute care setting is
recommended.
