Introduction In 2010, NICE published recommendations on cardiac imaging pathway for stable chest pain, which were updated in November 2016. The pre-test probability testing and calcium score consideration for Computed Tomography Coronary Angiogram (CTCA) were omitted from the updated recommendations. This audit aimed at assessing the compliance with NICE CG95, 2010 and whether our practice would support NICE CG95, 2016.
Methods A total of 500 subjects aged less than 70 years referred for a cardiac CT to investigate for stable chest pain from September 2015 to May 2016 were included. Data was retrospectively analysed in relation to risk stratification, CTCA findings and further downstream testing.
Results Out of 296 (59.2%) subjects who had a calcium score of ‘0’, 108 (36.5%) had undergone a CTCA. There were 193 (38.6%) subjects who had pre-test risk stratification less than 10% and had a cardiac CT study. Among the 182 (36.4%) subjects who had a risk score of 10%–29%, 24 (13.0%), had a functional imaging study and 4 (16.7%) of these were positive for ischaemia. In the risk stratification groups 30%–60% and 61%–90%, a total of 38 (30.0%) had functional imaging of which 8 (21.0%) were positive.
Conclusion The audit results confirm that there had been a clear trend towards following the standards stated in the CG95 updated 2016. Even in the intermediate to high risk group, only 30% of patients needed further functional imaging. Our audit supports the new recommendations and suggests that CTCA is a reliable, quick and a cost effective first line test in investigating patients with stable chest pain.
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