2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Circulation. 2021 Nov 30;144(22):e368-e454. doi: 10.1161/CIR.0000000000001029. Epub 2021 Oct 28.


Aim: This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.

Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.

Keywords: AHA Scientific Statements; accelerated diagnostic pathway; acute coronary syndrome; angina; biomarkers; cardiac imaging; chest pain; chest pain syndromes; clinical decision pathway; coronary artery disease; myocardial infarction; myocardial injury; myocardial ischemia; noncardiac; noncardiac chest pain; sex differences; shared decision-making; troponins.

Publication types

  • Evaluation Study
  • Practice Guideline
  • Review

MeSH terms

  • Algorithms*
  • American Heart Association
  • Chest Pain* / diagnosis
  • Chest Pain* / physiopathology
  • Chest Pain* / therapy
  • Humans
  • Observational Studies as Topic
  • Randomized Controlled Trials as Topic
  • Registries*
  • United States