It was great to see so many friends, colleagues, and trainees together in person to learn about cardiology and new advances for the first time at a major meeting in more than two years. It truly felt like an American College of Cardiology of old, with great attendance at live events, a full expo center, and thousands of clinicians interacting.

The major themes at this year's American College of Cardiology conference in Washington D.C. were the new 2021 chest pain guidelines and many papers focusing on the rising importance of anatomic imaging. There was discussion of the usage of tests, such as coronary artery calcium and CT angiography, and the decline of functional testing as a preferred modality. The new 2021 chest pain guidelines were featured, which elevated anatomic imaging with coronary computed tomographic angiography (CCTA) to a class IA recommendation while lowering functional testing to a class IB test.

There were numerous studies of plaque imaging being more diagnostically accurate, as well as affording better prognostication for future atherosclerotic cardiovascular disease events. Also focused was the early detection of atherosclerosis (subclinical disease), allowing clinicians to intervene when preventive therapies work best. Multiple presentations and abstracts demonstrated advances in automated plaque quantification with CCTA, coronary artery calcification, and functional assessment with fractional flow reserve – computed tomography (FFRct) which makes testing with CCTA more accurate and reading automated and faster.

There were numerous debates, trials, and abstracts that emphasized the superiority of anatomic testing, utilizing CCTA over nuclear testing. The guidelines were so favorable for CCTA and physiologic assessment using FFRct over nuclear testing that the American Society of Nuclear Cardiology withdrew its name from the writing group on the guidelines. Several keynote lectures and debates focused on this new algorithm of testing, which equates the rise of CCTA to what occurred with pulmonary CTA over nuclear volume/perfusion testing for pulmonary embolism. Twenty years ago, VQ testing was the primary method to evaluate pulmonary embolism. But due to better diagnostic accuracy and lower radiation exposure, pulmonary CTA studies are now the gold standard.

Dr Budoff is employed with the Lundquist Institute. He has received grants from General Electric and the NIH.

Illustration by April Brust