ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease

• Published in: Journal of cardiovascular magnetic resonance 2023-10, Vol.25 (1), p.58-58, Article 58
• Main Authors: Winchester, David E., Maron, David J., Blankstein, Ron, Chang, Ian C., Kirtane, Ajay J., Kwong, Raymond Y., Pellikka, Patricia A., Prutkin, Jordan M., Russell, Raymond, Sandhu, Alexander T.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome; Angiography; Appropriate Use Criteria; Arteriosclerosis; Asymptomatic; Atherosclerosis; Availability; Calcium imaging; Cardiology; Cardiovascular diseases; CCD; Chronic coronary disease; Clinical medicine; Computed tomography; Coronary Disease; Coronary heart disease; Criteria; CT imaging; Disease prevention; Documents; Echocardiography; Flow charts; Guidelines; Health risks; Heart diseases; Heart failure; Humans; Ischemia; Magnetic resonance; Medical imaging; Multimodality; Myocardial Ischemia; Patients; Physician and patient; Predictive Value of Tests; Radioisotopes; Ratings; Review; Risk Assessment; Risk factors; Surgeons; Syncope; Tomography; United States; Writing
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-023-00958-5

The American College of Cardiology (ACC) Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of stress testing and anatomic diagnostic procedures for risk assessment and evaluation of known or suspected chronic coronary disease (CCD), formerly referred to as stable ischemic heart disease (SIHD). This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging, stress echocardiography (echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. As with the prior version of this document, rating of test modalities is provided side-by-side for a given clinical scenario. These ratings are explicitly not considered competitive rankings due to the limited availability of comparative evidence, patient variability, and the range of capabilities available in any given local setting1–4. This version of the AUC for CCD is a focused update of the prior version of the AUC for SIHD4. Key changes beyond the updated ratings based on new evidence include the following: 1.Clinical scenarios related to preoperative testing were removed and will be incorporated into another AUC document under development.2.Some clinical scenarios and tables were removed in an effort to simplify the selection of clinical scenarios. Additionally, the flowchart of tables has been reorganized, and all clinical scenario tables can now be reached by answering a limited number of clinical questions about the patient, starting with the patient's symptom status.3.Several clinical scenarios have been revised to incorporate changes in other documents such as pretest probability assessment, atherosclerotic cardiovascular disease (ASCVD) risk assessment, syncope, and others. ASCVD risk factors that are not accounted for in contemporary risk calculators have been added as modifiers to certain clinical scenarios. The 64 clinical scenarios rated in this document are limited to the detection and risk assessment of CCD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines.5 These clinical scenarios do not specifically address patients having acute chest pain episodes. They may, however, be applicable in the inpatient setting if the patient is not having an acute coronary