scholarly journals 181 The prevalence of coronary artery disease in patients presenting to a rapid access chest pain clinic with ‘non-anginal chest pain’

2021 ◽  
Author(s):  
Will Chick ◽  
Anita Macnab
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Pain Clinic ◽  
Rapid Access ◽  
Artery Disease

scholarly journals Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95?

2019 ◽  
Vol 6 (2) ◽  
pp. 17-23 ◽  
Author(s):  
Victoria Pettemerides ◽  
Thomas Turner ◽  
Conor Steele ◽  
Anita Macnab
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Cardiac Death ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Pain Clinic ◽  
Major Adverse Cardiovascular Events ◽  
Rapid Access ◽  
Artery Disease

Introduction The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second-line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likely to continue to use stress testing for the foreseeable future. We share service evaluation data from our department to show that a negative stress echocardiogram can continue to be used for chest pain assessment. Methods 1815 patients were referred to rapid access chest pain clinic (RACPC) between June 2013 and March 2015. 802 patients had stress echocardiography as the initial investigation. 446 patients had normal resting left ventricular (LV) systolic function and a negative stress echocardiogram. At least 24 months after discharge, a survey was carried out to detect major adverse cardiovascular events (MACE) (cardiac death, myocardial infarction, admission to hospital for heart failure or angina, coronary artery disease at angiography, revascularisation by angioplasty or coronary artery bypass grafting) within 2 years. Results Overall, 351 patients were successfully followed up. The mean Diamond-Forrester (D-F) score and QRISK2 suggested a high pre-test probability (PTP) of coronary artery disease (CAD). There were nine deaths (eight non-cardiac deaths and one cardiac death). MACE occurred in four patients with a mean time of 17.5 months (11.6–23.7 months). The annual event rate was 0.6%. Conclusion A negative stress echocardiogram can reliably reassure patients and clinicians even in high PTP populations with suspected stable angina. It can continue to be used to assess stable chest pain post CG95.

scholarly journals Discrimination capability of pretest probability of stable coronary artery disease: a systematic review and meta-analysis suggesting how to improve validation procedures

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047677
Author(s):  
Pierpaolo Mincarone ◽  
Antonella Bodini ◽  
Maria Rosaria Tumolo ◽  
Federico Vozzi ◽  
Silvia Rocchiccioli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Quality Assessment ◽  
Meta Analysis ◽  
Stable Coronary Artery Disease ◽  
First Line ◽  
Discrimination Capability ◽  
Artery Disease

ObjectiveExternally validated pretest probability models for risk stratification of subjects with chest pain and suspected stable coronary artery disease (CAD), determined through invasive coronary angiography or coronary CT angiography, are analysed to characterise the best validation procedures in terms of discriminatory ability, predictive variables and method completeness.DesignSystematic review and meta-analysis.Data sourcesGlobal Health (Ovid), Healthstar (Ovid) and MEDLINE (Ovid) searched on 22 April 2020.Eligibility criteriaWe included studies validating pretest models for the first-line assessment of patients with chest pain and suspected stable CAD. Reasons for exclusion: acute coronary syndrome, unstable chest pain, a history of myocardial infarction or previous revascularisation; models referring to diagnostic procedures different from the usual practices of the first-line assessment; univariable models; lack of quantitative discrimination capability.MethodsEligibility screening and review were performed independently by all the authors. Disagreements were resolved by consensus among all the authors. The quality assessment of studies conforms to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A random effects meta-analysis of area under the receiver operating characteristic curve (AUC) values for each validated model was performed.Results27 studies were included for a total of 15 models. Besides age, sex and symptom typicality, other risk factors are smoking, hypertension, diabetes mellitus and dyslipidaemia. Only one model considers genetic profile. AUC values range from 0.51 to 0.81. Significant heterogeneity (p<0.003) was found in all but two cases (p>0.12). Values of I2 >90% for most analyses and not significant meta-regression results undermined relevant interpretations. A detailed discussion of individual results was then carried out.ConclusionsWe recommend a clearer statement of endpoints, their consistent measurement both in the derivation and validation phases, more comprehensive validation analyses and the enhancement of threshold validations to assess the effects of pretest models on clinical management.PROSPERO registration numberCRD42019139388.

Screening of Fabry Disease in Patients with Chest Pain Without Obstructive Coronary Artery Disease

2021 ◽  
Author(s):  
Aitor Hernández-Hernández ◽  
Carles Diez-López ◽  
Olga Azevedo ◽  
Julian Palomino-Doza ◽  
Fernando Alfonso ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Fabry Disease ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

scholarly journals Downstream testing after CT coronary angiography: time for a rethink?

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001597
Author(s):  
Gareth Morgan-Hughes ◽  
Michelle Claire Williams ◽  
Margaret Loudon ◽  
Carl A Roobottom ◽  
Alice Veitch ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Communication Systems ◽  
Ct Coronary Angiography ◽  
Second Line ◽  
Recent Onset ◽  
Line Test ◽  
Artery Disease

ObjectiveWe surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) ‘recent-onset chest pain’ guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.MethodsA prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.Results5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0–2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.ConclusionsWhile CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain—Low Probability of Coronary Artery Disease

2012 ◽  
Vol 9 (10) ◽  
pp. 745-750 ◽  
Author(s):  
Udo Hoffmann ◽  
Vikram Venkatesh ◽  
Richard D. White ◽  
Pamela K. Woodard ◽  
J. Jeffrey Carr ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Appropriateness Criteria ◽  
Acr Appropriateness Criteria ◽  
Low Probability ◽  
Artery Disease

Chest Pain in a Patient With Coronary Artery Disease Taking Clopidogrel

2013 ◽  
Vol 144 (1) ◽  
pp. e13-e14 ◽  
Author(s):  
Sang Pyo Lee ◽  
Hang Lak Lee ◽  
Kang Nyeong Lee
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Disease
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