Methods This is a retrospective study at a district general hospital. We identified high CAD risk patients who were referred for DSE from the rapid access chest pain (RACP) clinic. We clarified the reasons why patients were not referred for coronary angiography. Patients with negative DSE were followed up via the hospital’s electronic record system, which contains all clinical information including hospital admissions and discharge letters, outpatient attendances and clinical letters, diagnostic tests and results, and date of death.

Results 504 patients were referred for DSE from the RACP clinic between September 2010 and August 2012. 164 patients possessed high risk for CAD. 52 were referred based on patient choice, 54 based on clinical assessment, and 7 possessed contraindications to invasive angiography. 117 high risk patients had a negative DSE; these patients were followed up for at least 12 months (median 21 months, maximum 30 months). 4 (3.4%) high CAD risk patients required further hospital review due to persistent cardiac symptoms and additional cardiac investigations following a negative DSE. Within this group, 1 case (0.8%) had significant CAD identified on angiography requiring percutaneous coronary intervention. The remaining 113 (96.6%) were free from significant clinical complaints requiring hospital attendance during follow up.

Conclusion In the first 2 years following the implementation of NICE CG95, we identified a significant number of patients with high CAD risk, who were offered DSE. The reasons for selecting DSE over conventional angiography were due to the clinician’s judgement of appropriateness and patient choice in equal parts. The medium term outcome of those who have had a negative DSE is favourable, with only a few (<5%) requiring additional cardiac investigation and 1 case (<1%) of significant coronary disease. Thus, a negative DSE is a reliable objective indicator of good prognosis in patients with high risk of CAD in a chest pain clinic.