Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95?
Echo Res Pract. 2019 Mar 01;:
Authors: Pettemerides V, Turner TJ, Steele C, Macnab A
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 the 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 cardiac events (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 two years.
RESULTS: 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 9 deaths (8 non-cardiac deaths and 1 cardiac death). MACE occurred in 4 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 pre-test probability populations with suspected stable angina. It can continue to be used to post CG95.
PMID: 30893640 [PubMed - as supplied by publisher]