Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool, UK.
Postgrad Med J. 2011 Jul;87(1029):445-9. doi: 10.1136/pgmj.2010.112003. Epub 2011 Mar 15.
Chest pain or discomfort due to angina can have a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. The National Institute for Health and Clinical Excellence (NICE) published 'Chest pain of recent onset' guidelines in March 2010. These guidelines appraise the role of newer non-invasive modalities in cardiac imaging in the prompt and cost-effective diagnosis of coronary artery disease.
To study the service requirement for non-invasive cardiac imaging in patients with stable chest pain using current NICE guidance.
Single-centre, 6-month (January 2010 to June 2010) observational study.
Rapid access chest pain clinics in a large university teaching hospital providing secondary care cardiology services.
Clinic letters were used to ascertain the type of chest pain and cardiovascular risk factors. The resting 12-lead ECG was examined for any ischaemic changes. Patients were then retrospectively allocated to an assessment pathway based on NICE guidance for the evaluation of stable chest pain. Pretest likelihood of coronary artery disease was calculated using Pryor et al's table as published by NICE. Depending on the calculated pretest probability, their NICE-suggested investigation was determined. This included no further investigations, cardiac CT, functional imaging or invasive angiography.
500 patients were seen in rapid access chest pain clinics, 65 of which did not meet the referral criteria of having chest pain. On the basis of previous practice, 52% of patients were likely to have an exercise tolerance test. According to current NICE guidance as applied to our cohort of patients, 128 (30%) would have required functional imaging, 119 (27%) no further investigation, 95 (22%) cardiac CT, and 93 (21%) invasive angiography.
Functional imaging and then cardiac CT are the main investigations required in the assessment of patients with stable chest pain.
心绞痛引起的胸痛或不适可能预后较差，这强调了及时准确诊断的重要性。国家卫生与临床优化研究所（NICE）于 2010 年 3 月发布了“近期发作胸痛”指南。这些指南评估了新型非侵入性心脏成像技术在快速且具成本效益的诊断冠状动脉疾病中的作用。
根据当前 NICE 指南研究稳定型胸痛患者对非侵入性心脏成像的服务需求。
单中心、6 个月（2010 年 1 月至 2010 年 6 月）观察性研究。
在一家大型大学教学医院的快速通道胸痛诊所，提供二级心脏科服务。
使用诊所信件确定胸痛类型和心血管危险因素。检查静息 12 导联心电图是否有任何缺血变化。然后根据 NICE 指南对稳定型胸痛的评估，回顾性分配患者到评估路径。使用 Pryor 等人发表的表格根据 NICE 计算冠心病的术前可能性。根据计算出的术前概率，确定他们的 NICE 建议的检查。这包括无需进一步检查、心脏 CT、功能成像或有创血管造影。
在快速通道胸痛诊所就诊的 500 名患者中，有 65 名不符合有胸痛的转诊标准。根据以往的做法，52%的患者可能需要进行运动耐量试验。根据当前应用于我们患者队列的 NICE 指南，128 名（30%）需要功能成像，119 名（27%）无需进一步检查，95 名（22%）心脏 CT，93 名（21%）有创血管造影。
功能成像，然后是心脏 CT，是评估稳定型胸痛患者的主要检查方法。
