The consequences of applying NICE chest pain guidelines to an acute medical population: a role for cardiac computed tomography.
BACKGROUND
Cardiac computed tomography (CCT) is a well-validated investigation for the non-invasive assessment of coronary artery disease (CAD). The National Institute for Clinical Excellence (NICE) have recently released guidelines incorporating CCT into the diagnostic algorithm for chest pain of recent onset.


OBJECTIVE
To assess the frequency of eligibility for CCT in medical admissions with suspected cardiac chest pain using criteria defined by NICE.


METHODS
A retrospective, observational study, set in a teaching hospital acute medical unit.


METHODS
A total of 198 consecutive patients admitted over a 4-month period with suspected cardiac chest pain (57% male; mean age 63.5 years) were assessed for eligibility for CCT based on NICE guideline criteria.


RESULTS
Of the 198 patients admitted, 65 (33%) patients were excluded by a raised troponin I or ischaemic ECG changes; 100 (51%) patients were excluded by pain categorized as non-anginal and 171 (86%) patients were excluded by a modified Diamond Forrester score outside the range 10-29%. Applying NICE criteria to this population ultimately resulted in 2 (1%) patients recommended for CCT, 12 (6%) for functional cardiac testing and 17 (9%) for invasive angiography.


CONCLUSIONS
Applying current NICE guidelines for chest pain of recent onset to medical admissions results in a lesser uptake of CCT than functional testing and invasive angiography. If the NICE guidelines are revised to include patients with an intermediate pre-test probability of CAD, CCT may have a greater role.
Patterson
C
C
Department of Medicine and Therapeutics, Chelsea and Westminster Hospital, London SW10 9NH, UK. cmpatterson@doctors.net.uk
Bryan
L
L
Nicol
E
E
Duncan
M
M
Bell
D
D
Padley
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013222:State Medicine; D014057:Tomography, X-Ray Computed; D006113:United Kingdom; D055815:Young Adult