RATIONAL IMAGING: Investigating stable chest pain of suspected cardiac origin

LEARNING POINTS The National Institute for Health and Care Excellence (NICE) does not recommend exercise electrocardiography for investigating stable chest pain in patients without known coronary artery disease NICE guidance recommends that the sequence of imaging tests be determined by the patient&...

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Bibliographic Details
Published in:BMJ (Online) 2013-09, Vol.347 (7926), p.30-33
Main Authors: O'Regan, Declan P, Harden, Stephen P, Cook, Stuart A
Format: Article
Language:English
Subjects:
Calcium
Chest pain
Computerized axial tomography
Coronary angiography
Coronary artery disease
Coronary vessels
Disease risk
Imaging
Magnetic resonance imaging
Perfusion
PRACTICE
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Summary:LEARNING POINTS The National Institute for Health and Care Excellence (NICE) does not recommend exercise electrocardiography for investigating stable chest pain in patients without known coronary artery disease NICE guidance recommends that the sequence of imaging tests be determined by the patient's risk of coronary artery disease Patients with a pre-test probability of 10-29% for coronary artery disease are initially investigated with coronary artery calcium scoring using computed tomography Computed tomography coronary angiography is performed in patients with a calcium score of 1-400 to determine whether there are any coronary stenoses Patients with a 30-60% risk are initially investigated with functional cardiac imaging to diagnose flow limiting coronary disease Invasive coronary angiography, as a first line investigation, is reserved for symptomatic patients with a 61-90% pre-test probability of coronary artery disease when revascularisation is a treatment option
ISSN:0959-8138
1756-1833
DOI:10.1136/bmj.f3940