The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease

Abstract

Purpose of ReviewCost-effective care pathways are integral to delivering sustainable healthcare programmes. Due to the overestimation of coronary artery disease using traditional risk tables, non-invasive testing has been utilised to improve risk stratification and initiate appropriate management to reduce the dependence on invasive investigations. In line with recent technological improvements, cardiac CT is a modality that offers a detailed anatomical assessment of coronary artery disease comparable to invasive coronary angiography.Recent FindingsThe recent publication of the National Institute for Health and Care Excellences (NICE) Clinical Guideline 95 update assesses the performance and cost utility of different non-invasive imaging strategies in patients presenting with suspected anginal chest pain. The low cost and high sensitivity of cardiac CT makes it the non-invasive test of choice in the evaluation of stable angina. This has now been ratified in national guidelines with NICE recommending cardiac CT as the first-line investigation for all patients presenting with chest pain due to suspected coronary artery disease. Additionally, randomised controlled trials have demonstrated that cardiac CT improves diagnostic certainty when incorporated into chest pain pathways.SummaryNICE recommend cardiac CT as the first-line test for the evaluation of stable coronary artery disease in chest pain pathways.

Long‐term follow‐up of patients undergoing standardized bicycle exercise stress testing: new recommendations for grading of exercise capacity are clinically relevant

“…In a recent study (Lindow et al, 2018), 37 % of patients were classified as having reduced exercise capacity using the new reference material compared to 17 % with previous reference values ('the Kristianstad material') (Nordenfelt et al, 1985). In recent years, other diagnostic modalities have been suggested to be preferred over either treadmill or bicycle exercise stress testing in patients with suspected angina pectoris, since the diagnostic accuracy has been reported to be low (Moss et al, 2017;Knuuti et al, 2018). Although more patients are now classified as having reduced exercise capacity, compared with the previous reference values, the present findings support that this grading is highly clinically relevant.…”

“…Although more patients are now classified as having reduced exercise capacity, compared with the previous reference values, the present findings support that this grading is highly clinically relevant. In recent years, other diagnostic modalities have been suggested to be preferred over either treadmill or bicycle exercise stress testing in patients with suspected angina pectoris, since the diagnostic accuracy has been reported to be low (Moss et al, 2017;Knuuti et al, 2018). This is emphasized in recent guidelines from the European Society of Cardiology, where exercise ECG is no longer the initial test to be used to establish a diagnosis of stable coronary artery disease (Knuuti et al, 2019).…”

A koronária-CT bevezetésének első tapasztalatai a Bajcsy-Zsilinszky Kórházban

“…Az Európai Kardiológiai Társaság 2019-es Krónikus Koronáriaszindróma irányelvében az új, alacsonyabb pre-teszt kal nagyobb hányadánál kizárható a koronáriabetegség szerepet kapnak a nonnvazív tesztek. 5%-os pre-teszt --rúér-betegség irányú további kivizsgálás (4). Az általunk vizsgált betegek átlagos PTP-je az utóbbi két csoport határát közelíti, amely alapján a klinikai gyakorlat ilyen tekintetben összhangban van az ajánlással.…”

Novel molecular targets for coronary angiogenesis and ischemic heart disease

“…24 Other modalities for non-diagnostic workup include rest echocardiography, electrocardiography and stress testing.…”