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The 2016 National Institute for Health and Care Excellence guidelines for chest pain: better outcomes with cardiac CT
  1. Matthew J Budoff
  1. Correspondence to Dr Matthew J Budoff, Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 W Carson Street, Torrance, CA 90502, USA; mbudoff{at}labiomed.org, budoff{at}ucla.edu

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In the Heart paper by Adamson et al,1 the authors outline the diagnostic and prognostic benefits of CT coronary angiography (CTCA) in the context of the new 2016 National Institute for Health and Care Excellence (NICE) guidelines for evaluation of chest pain.2 This information, on how to maximise utility of CTCA while minimising unnecessary invasive angiography, is critical for physicians, patients and payors. While CTCA has been demonstrated to be more accurate than functional testing and prognostically superior, it has been burdened with a higher rate of invasive angiography, which has led some to discourage its use.

The study by Adamson et al1 proves, for probably the first time, that CTCA guideline-directed care can not only reduce future myocardial infarction, but not lead to an increase in the use of invasive angiography. The most important finding in this context is that individuals classified with possible angina derived large benefits from CTCA, while those with non-anginal chest pain did not. This provides critical reassurance that this test can assist clinicians in identifying patients that will derive the maximum benefit from CTCA, without increasing unnecessary invasive angiography. Direct visualisation of atherosclerosis with CTCA has always been a concept that made intuitive sense. The …

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