The American Society of Nuclear Cardiology (ASNC) has chosen not to endorse the years-in-the-marking chest pain guidelines recently published by the American Heart Association (AHA) and American College of Cardiology (ACC).
The guidelines, published Oct. 28, made headlines throughout the industry—but ASNC representatives said they had multiple problems with the final document. They shared their full analysis of the guidelines in an email
“Despite ASNC’s policy of collaboration and inclusivity and its long track record of collaborative guideline development, we are unable to endorse the current AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain,” first author Randall C. Thompson MD, a specialist with St. Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues in the group’s analysis. “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. We believe that the document fails to provide unbiased guidance to healthcare professionals on the optimal evaluation of patients with chest pain.”
Thompson et al. acknowledged that numerous industry organizations, including the ASNC, were asked to collaborate on these guidelines. In fact, one ASNC representative served on the document’s writing committee, and two other representatives reviewed the guidelines in advance.
Ultimately, however, the society found that “the guidelines did not cross the threshold we felt was need to be truly patient centered.”
“We want to be clear,” the authors wrote. “There are many excellent, evidence-based recommendations in the new guideline. There are also some troubling recommendations and some omissions that, in the end, ASNC cannot support.”
So, what were the group’s concerns?
First, ASNC representatives worried that fractional flow reserve computed tomography (FFR-CT) was given “an inappropriately large role” in the final document. The modality does have its benefits, they wrote, but “its overall diagnostic accuracy is still low” and its availability may be limited due to the fact that only one company provides FFR-CT. Also, the authors said they were “surprised” that more time was not given to detailing “the cost or limitations of FFR-CT.”
Another huge concern among ASNC representatives was that the guideline did not put a heavy enough emphasis on patient-first imaging. Selecting the right exam for the right patient is crucial, they wrote, and that decision often comes down to details such as patient preference or availability. ASNC’s members did not think this was addressed enough in the AHA/ACC document.
The group also said they felt that there was not enough detail about the benefits of multimodality testing. And stress testing modalities, they wrote, “should not be lumped together.”
“All stress imaging tests have their unique advantages and limitations, and there are important differences in sensitivity and specificity and strengths and limitations between exercise ECG, stress echo, SPECT MPI, PET MPI and stress MRI,” they wrote.
Click here to read group’s full evaluation of the guidelines on the Zenodo open-access server.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.