Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95?
Introduction: The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second-line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likel...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | Echo Research and Practice |
| Subjects: | |
| Online Access: | https://erp.bioscientifica.com/view/journals/echo/6/2/ERP-18-0082.xml |
| _version_ | 1811291145870770176 |
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| author | Victoria Pettemerides Thomas Turner Conor Steele Anita Macnab |
| author_facet | Victoria Pettemerides Thomas Turner Conor Steele Anita Macnab |
| author_sort | Victoria Pettemerides |
| collection | DOAJ |
| description | Introduction: The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second-line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likely to continue to use stress testing for the foreseeable future. We share service evaluation data from our department to show that a negative stress echocardiogram can continue to be used for chest pain assessment.
Methods: 1815 patients were referred to rapid access chest pain clinic (RACPC) between June 2013 and March 2015. 802 patients had stress echocardiography as the initial investigation. 446 patients had normal resting left ventricular (LV) systolic function and a negative stress echocardiogram. At least 24 months after discharge, a survey was carried out to detect major adverse cardiovascular events (MACE) (cardiac death, myocardial infarction, admission to hospital for heart failure or angina, coronary artery disease at angiography, revascularisation by angioplasty or coronary artery bypass grafting) within 2 years.
Results: Overall, 351 patients were successfully followed up. The mean Diamond-Forrester (D-F) score and QRISK2 suggested a high pre-test probability (PTP) of coronary artery disease (CAD). There were nine deaths (eight non-cardiac deaths and one cardiac death). MACE occurred in four patients with a mean time of 17.5 months (11.6–23.7 months). The annual event rate was 0.6%.
Conclusion: A negative stress echocardiogram can reliably reassure patients and clinicians even in high PTP populations with suspected stable angina. It can continue to be used to assess stable chest pain post CG95. |
| first_indexed | 2024-04-13T04:25:07Z |
| format | Article |
| id | doaj.art-7f25874fb5db401fa64f309424a1515c |
| institution | Directory Open Access Journal |
| issn | 2055-0464 2055-0464 |
| language | English |
| last_indexed | 2024-04-13T04:25:07Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Echo Research and Practice |
| spelling | doaj.art-7f25874fb5db401fa64f309424a1515c2022-12-22T03:02:35ZengBMCEcho Research and Practice2055-04642055-04642019-04-01621723https://doi.org/10.1530/ERP-18-0082Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95?Victoria Pettemerides0Thomas Turner1Conor Steele2Anita Macnab3Manchester University Foundation Trust, North West Heart Centre, Wythenshawe Hospital, Manchester, UKUniversity of Manchester Faculty of Biology, Medicine and Health, Manchester, UKUniversity of Manchester Faculty of Biology, Medicine and Health, Manchester, UKManchester University Foundation Trust, North West Heart Centre, Wythenshawe Hospital, Manchester, UKIntroduction: The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second-line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likely to continue to use stress testing for the foreseeable future. We share service evaluation data from our department to show that a negative stress echocardiogram can continue to be used for chest pain assessment. Methods: 1815 patients were referred to rapid access chest pain clinic (RACPC) between June 2013 and March 2015. 802 patients had stress echocardiography as the initial investigation. 446 patients had normal resting left ventricular (LV) systolic function and a negative stress echocardiogram. At least 24 months after discharge, a survey was carried out to detect major adverse cardiovascular events (MACE) (cardiac death, myocardial infarction, admission to hospital for heart failure or angina, coronary artery disease at angiography, revascularisation by angioplasty or coronary artery bypass grafting) within 2 years. Results: Overall, 351 patients were successfully followed up. The mean Diamond-Forrester (D-F) score and QRISK2 suggested a high pre-test probability (PTP) of coronary artery disease (CAD). There were nine deaths (eight non-cardiac deaths and one cardiac death). MACE occurred in four patients with a mean time of 17.5 months (11.6–23.7 months). The annual event rate was 0.6%. Conclusion: A negative stress echocardiogram can reliably reassure patients and clinicians even in high PTP populations with suspected stable angina. It can continue to be used to assess stable chest pain post CG95.https://erp.bioscientifica.com/view/journals/echo/6/2/ERP-18-0082.xmlstable chest paincoronary artery diseaseexercise echocardiographydobutamine stress echocardiography |
| spellingShingle | Victoria Pettemerides Thomas Turner Conor Steele Anita Macnab Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? Echo Research and Practice stable chest pain coronary artery disease exercise echocardiography dobutamine stress echocardiography |
| title | Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? |
| title_full | Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? |
| title_fullStr | Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? |
| title_full_unstemmed | Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? |
| title_short | Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? |
| title_sort | does stress echocardiography still have a role in the rapid access chest pain clinic post nice cg95 |
| topic | stable chest pain coronary artery disease exercise echocardiography dobutamine stress echocardiography |
| url | https://erp.bioscientifica.com/view/journals/echo/6/2/ERP-18-0082.xml |
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