title: Comparison of ESC and NICE guidelines for patients with suspected coronary artery disease: evaluation of the pre-test probability risk scores in clinical practice.
abstract: The European Society of Cardiology (ESC) and UK National Institute for Health and Care Excellence (NICE) have recently published guidelines for investigating patients with suspected coronary artery disease (CAD). Both provide a risk score (RS) to assess the pre-test probability for CAD to guide clinicians to undertake the most effective investigation. The aim of the study was to establish whether there is a difference between the two RS models. We retrospectively reviewed records of 479 patients who presented to a UK district general hospital with chest pain between August 2011 and April 2013. The RS was calculated using ESC and NICE guidelines and compared. From the 479 patients, 277 (58%) were male and the mean age was 60 years. The mean RS was greater using NICE guidelines compared with ESC (66.3 vs 47.9%, 18.4% difference; p<0.0001). The difference in mean RS was smaller in patients with typical chest pain (13.0%). When we divided the cohort based on NICE criteria into 'high'- and 'low'-risk groups, the difference in the mean RS was 24.3% in the 'high'-risk group (p<0.001) compared with 2.8% in the 'low'-risk group. The UK NICE risk score model overestimates risk compared with the ESC model.
authors.affiliation: Department of Cardiology, University Hospital Lewisham, London, UK.
authors.forename: Ozan M
authors.initials: OM
authors.lastname: Demir
authors.affiliation: Department of Cardiology, University Hospital Lewisham, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Dobson
authors.affiliation: Department of Cardiology, University Hospital Lewisham, London, UK.
authors.forename: Nikolaos D
authors.initials: ND
authors.lastname: Papamichael
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.affiliation: Department of Cardiology, University Hospital Lewisham, London, UK, and Department of Cardiology, King's College Hospital, London, UK khaled.alfakih@nhs.net.
authors.forename: Khaled
authors.initials: K
authors.lastname: Alfakih
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D019983:Guideline Adherence; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
keywords: Ischemic heart disease; angina; cardiac CT; non-invasive functional tests; stress echocardiogram