Comparison of NICE and ESC strategy for risk assessment in women with stable chest pain: a coronary computed tomography angiography study

Abstract

Background: For women presenting with stable chest pain (SCP), the appropriate risk assessment strategy to identify individuals unlikely to benefit from further cardiovascular imaging testing (CIT) is debatable. Thus, the present study intended to compare two risk assessment strategies in these individuals. Methods: 2592 women with SCP who underwent coronary computed tomography angiography (CCTA) were divided into low and high risk group according to 2016 National Institute of Health and Care Excellence guideline-determined strategy (NICE strategy) and 2019 European Society of Cardiology guideline-determined strategy (ESC strategy), respectively. The associations of coronary artery disease (CAD), major adverse cardiovascular event (MACE) and other subsequent clinical outcomes with risk groups and net reclassification improvement (NRI) were evaluated to compare different strategies. Results: Both NICE strategy which focused on symptom evaluation and ESC strategy which was based on pretest probability (PTP) determined by ESC-PTP model and coronary artery calcium score-weighted clinical likelihood (CACS-CL) model classified a proportion (34.49% and 63.97%, respectively) of individuals into the low risk group. Compared to NICE strategy, ESC strategy indicated stronger associations between risk groups and obstructive CAD (odds ratio: 27.63 versus 3.57), MACE (hazard ratios: 4.24 versus 1.91), more intensive clinical management as well as a positive NRI (27.71%, p < 0.0001). Conclusion: Compared to NICE strategy, ESC strategy which sequentially incorporated ESC-PTP model with CACS-CL model seemed to be associated with greater effectiveness in identifying individuals who may derive maximum benefit from further CIT in women presenting with SCP.

Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes

“…This led to its update considering the contribution of pre-test probability overestimation to low diagnostic yield in invasive and non-invasive testing [ 19 ]. The newer ESC model proposed in 2019 integrated patients whose main symptom upon presentation is dyspnea and has since been validated and found to provide a more reasonable classification of the likelihood of obstructive CAD in patients compared to the previous 2013 model, as well as other models (National Institute for Health and Clinical Excellence (NICE) 2016 model and the CAD Consortium basic score) [ 20 – 23 ]. Using pre-test probability assessment, diagnostic imaging can be safely avoided or delayed in patients with pre-test probability<15% in the absence of compelling reasons [ 15 , 16 ], which will in turn reduce unnecessary use of resources and unnecessary testing in patients with stable chest pain/suspected CAD.…”

Comparison of the RF-CL and CACS-CL models to estimate the pretest probability of obstructive coronary artery disease and predict prognosis in patients with stable chest pain and diabetes mellitus

“…The RF-CL model (age, sex, type of SCP, DM, hypertension, hyperlipidemia, family history, and smoking) and CACS-CL model (age, sex, type of SCP, DM, hypertension, hyperlipidemia, family history, smoking, and CACS) were used to estimate the PTP of obstructive CAD as previously reported, and the R packages are available at https://github.com/CardioLab/cadptp/tree/master/R (10). According to the current guidelines (8,14) and our previous works (11,19), CIT should be deferred for a low-risk patient, and the impact of PTP on outcome was tested by classifying patients into different risk groups. The details of the risk groups are illustrated in Figure 1, and according to the RF-CL and CACS-CL models, patients with PTP ≤ 15% were divided into the low-risk group, and patients with PTP > 15% were divided into the high-risk group.…”

Diagnostic algorithms in patients with chronic coronary syndromes — what does clinical practice show?

“…Несмотря на вышеприведенные рассуждения, прямое сопоставление стратегии NICE с диагностической стратегией ЕОК-2019, которая включала модель ЕОК-ПТВ и модель CACS-CL [17], показало, что последняя больше больных относила в группу низкого риска (34,49% и 63,97%, соответственно). Также по сравнению со стратегией NICE, стратегия ЕОК показала более сильную связь между группами риска и обструктивной ИБС (отношение рисков (ОР) 27,63 vs 3,57), MACE (ОР 4,24 vs 1,91), и улучшение реклассификации в 27,71% (p<0,0001) [26].…”