Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low‐risk chest pain in the emergency department

作者：Paul I. Musey, Fernanda Bellolio, Suneel Upadhye, Anna Marie Chang, Deborah B. Diercks, Michael Gottlieb, Erik P. Hess, Michael C. Kontos, Bryn E. Mumma, Marc A. Probst, John H. Stahl, Jason P. Stopyra, Jeffrey A. Kline, Christopher R. Carpenter · 发表于：Academic Emergency Medicine · 年份：2021 · DOI：10.1111/acem.14296 · 被引用次数：47 · 研究领域：Cardiac, Anesthesia and Surgical Outcomes、Acute Myocardial Infarction Research、Cardiac Imaging and Diagnostics

This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low-risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low-risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high-sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non-obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedi...