Moss Alastair J, Williams Michelle C, Newby David E, Nicol Edward D
University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK.
Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, Sydney Street, London, SW3 6NP UK.
Curr Cardiovasc Imaging Rep. 2017;10(5):15. doi: 10.1007/s12410-017-9412-6. Epub 2017 Mar 27.
Cost-effective care pathways are integral to delivering sustainable healthcare programmes. Due to the overestimation of coronary artery disease using traditional risk tables, non-invasive testing has been utilised to improve risk stratification and initiate appropriate management to reduce the dependence on invasive investigations. In line with recent technological improvements, cardiac CT is a modality that offers a detailed anatomical assessment of coronary artery disease comparable to invasive coronary angiography.
The recent publication of the National Institute for Health and Care Excellences (NICE) Clinical Guideline 95 update assesses the performance and cost utility of different non-invasive imaging strategies in patients presenting with suspected anginal chest pain. The low cost and high sensitivity of cardiac CT makes it the non-invasive test of choice in the evaluation of stable angina. This has now been ratified in national guidelines with NICE recommending cardiac CT as the first-line investigation for all patients presenting with chest pain due to suspected coronary artery disease. Additionally, randomised controlled trials have demonstrated that cardiac CT improves diagnostic certainty when incorporated into chest pain pathways.
NICE recommend cardiac CT as the first-line test for the evaluation of stable coronary artery disease in chest pain pathways.
具有成本效益的护理路径是实施可持续医疗保健计划不可或缺的一部分。由于使用传统风险表对冠状动脉疾病的高估，已采用非侵入性检测来改善风险分层并启动适当的管理措施，以减少对侵入性检查的依赖。随着近期技术的进步，心脏CT是一种能够提供与侵入性冠状动脉造影相当的冠状动脉疾病详细解剖评估的检查方式。
英国国家卫生与临床优化研究所（NICE）临床指南95更新版的近期发布，评估了不同非侵入性成像策略在疑似心绞痛胸痛患者中的性能和成本效益。心脏CT的低成本和高敏感性使其成为评估稳定型心绞痛的首选非侵入性检查。这一点现已在国家指南中得到认可，NICE推荐心脏CT作为所有因疑似冠状动脉疾病而出现胸痛患者的一线检查。此外，随机对照试验表明，将心脏CT纳入胸痛诊疗路径可提高诊断的确定性。
NICE推荐心脏CT作为胸痛诊疗路径中评估稳定型冠状动脉疾病的一线检查。
