Abstract Objectives Computed tomography coronary angiography (CTCA) is a well established diagnostic modality for coronary heart disease (CHD) in stable chest pain strongly endorsed by NICE guidelines. Bottlenecks arising from outpatient capacity constraints add significant delays to rapid access chest pain (RACP) pathways. We evaluated a novel direct track to CTCA from primary care prior to RACP assessment. Methods Patients referred from primary care to an urban academic medical centre (catchment population 650,000) were prospectively vetted direct to CTCA (based on eligibility per NICE CG95) between 5/6/2024 and 29/01/2025. Patients with known CHD or those with contra-indication to CTCA imaging (end stage renal disease or contrast allergy) were excluded. Patients were contacted and offered to participate in this novel pathway. If they declined, patients stayed on the standard-care pathway. A 640-detector scanner (Aquilon ONE, Canon-Toshiba) and sublingual GTN spray was used. Where required, patients received intravenous metoprolol for heart rate control(target 60 b.p.m.) immediately before scan acquisition Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. Results One hundred and forty-nine patients (mean age 55 ± 10 years, range 25-81, 34% female) underwent cardiologist supervised CTCA (see figure 1). The presenting symptoms were: non-specific chest pain (24, 14%); atypical chest pain (75,50%); typical chest pain (54, 36%). A majority were diagnosed with no or non-obstructive coronary artery disease by CAD-RADS (Coronary Artery Disease Reporting and Data System) score: 32%, score 0 (no CHD); 37%, score 1-2 (CAD requiring medical therapy); 30%, score 3-5 (moderate-severe CAD). Further face-to-face RACP consultations were only required in 47 (32%) of patients. Only 26 (17%) of patients required exercise electrocardiography at clinic assessment and 22 (15%) underwent invasive coronary angiography for refractory angina. Relevant informant findings were demonstrated in 43 (29) patients (see table 1); 4 (3%) required additional speciality review (respiratory, gastroenterology) for suspected malignancy. Median time to diagnosis was significantly shorter compared to conventional pathway (29 days IQR: 21-41 vs 88 days IQR 84-101). Based on this pathway’s capacity (6 CTCA slots per week) we extrapolated yearly saving of £26,492. Conclusion A direct-to-CTCA approach is a feasible strategy for patients without pre-existing CHD referred to RACP. A unique strength is tailoring preventative therapy based on CTCA findings. Significant reduction in hospital appointments has major implications for relieving congested cardiology pathways.Fig 1 Table 1:Follow-on testing
Ahmad et al. (Sat,) studied this question.