Most of us don't read guideline documents but do pick a point or two to support our own opinions, like selecting verses from the Bible. The new 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain is an extensive review of the available evidence and considered expert opinion . Participation of the organizations listed in the title gives a clue to one major emphasis of the document, a strong focus on the non-invasive workup of chest pain. That is why the gold-standard imaging method for evaluation of chest pain and diagnosis of coronary artery disease, invasive coronary angiography (ICA), is not included as a diagnostic method. The absence of the Society for Cardiovascular Angiography and Interventions (SCAI) from the participating organizations was probably intentional. Not because of dislike for those of you who work in cath labs, but because of the belief that coronary arteriography is no longer a diagnostic tool but just a component of an interventional procedure. A sentence from the guideline is telling – “For ICA, the primary goal is the characterization and detection of a high grade obstructive stenosis to define feasibility and necessity of percutaneous or surgical revascularization.” This is a major change from the understanding of the use of coronary arteriography in the years prior to the broad utilization of percutaneous coronary intervention (PCI). Before PCI was widely practiced, a diagnostic cath was a thing, but now it is viewed mainly as part of an intervention.