Imaging group says new guidelines for chest pain contain some ‘troubling recommendations’
Leading cardiology groups released long-awaited guidelines for managing chest pain on Thursday, but one imaging advocate has “major” concerns with the update.
The American Heart Association and American College of Cardiology recommendations are meant to help clinicians evaluate the source and symptoms of chest pain while improving outcomes and reducing healthcare costs. It’s the first time both advocates have collaborated on such a document.
While many have praised the multi-year effort, including one company labeling it a “watershed moment,” the American Society of Nuclear Cardiology took issue with multiple aspects and said it cannot endorse the document.
“There are many excellent, evidence-based recommendations in the new guideline,” Randall Thompson, MD, president of ASNC, and Dennis Calnon, MD, president-elect of the advocacy group, wrote in an update shared Friday. “There also are some troubling recommendations and some omissions that, in the end, ASNC cannot support.”
The doctors and others outlined five specific concerns in a new editorial.
Along with a “major” worry that fractional flow reserve-CT was given an “inappropriately” large role in evaluating chest pain, experts believe multimodality imaging and risk scores were shortchanged. Thompson et al. added that all stress testing (SPECT MPI, PET MPI, etc.) should not be bundled together and expressed concerns the guidance may promote harmful test substitution policies.
“The lack of balance in the document’s presentation of the science on FFR-CT and its inappropriately prominent endorsement detract from ASNC’s core principle of patient first imaging,” the authors wrote. “We believe that the document fails to provide unbiased guidance to healthcare professionals on the optimal evaluation of patients with chest pain.”
On the flip side, the Society of Cardiovascular Computed Tomography helped develop the guidelines and endorsed them in its own statement published Thursday. SCCT pointed to coronary CT angiography’s now-prominent role in managing stable and acute chest pain.
“We now have more than a decade of clinical trial evidence to show that coronary CTA is a highly effective, non-invasive and cost-saving test. By using CT, we can better diagnose and treat our patients without putting them through unnecessary procedures,” SCCT wrote Thursday.
Read the full guidelines published in Circulation and the Journal of the American College of Cardiology here.
Related Cardiac CT Content:
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‘A watershed moment’: HeartFlow praises new chest pain guidelines
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Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.