Assessing and modifying cardiovascular risk in people who present to a chest pain clinic with non‐cardiac causes

Managing patients with acute chest pain should include opportunistic discussion of strategies for preventing coronary artery disease

Chest pain is a frequent symptom in patients presenting to emergency departments. Assessing blood troponins is critical for rapid diagnosis,1 and guidelines clearly outline therapeutic strategies for patients diagnosed with acute myocardial infarction.2 However, evidence for guiding further management when myocardial infarction has been excluded — that is, for most people who present with chest pain — is less definite. As the risk of myocardial infarction or death within 12 months for such patients is 2–9%,1 accurate risk estimation and further preventive treatment are important. The 2020 European Society of Cardiology guidelines for non‐ST‐elevation myocardial infarction recommend non‐invasive cardiac imaging in patients without acute coronary syndrome only when coronary artery disease is nevertheless suspected.3 Further evaluation is often undertaken in chest pain clinics.