Why the study?
The appropriate risk assessment strategy to identify women with stable chest pain unlikely to benefit from further cardiovascular imaging testing is debatable.
Does the 2019 ESC risk assessment strategy improve risk stratification compared to the 2016 NICE strategy in women with stable chest pain?
Does the 2019 ESC risk assessment strategy improve risk stratification compared to the 2016 NICE strategy in women with stable chest pain?
The 2019 ESC risk assessment strategy, incorporating pretest probability and coronary artery calcium score, is more effective than the 2016 NICE symptom-based strategy in identifying women with stable chest pain who are at low risk and unlikely to benefit from further imaging.
ESC strategy may better defer CIT in low-risk women with SCP; leaves open whether it improves outcomes without prospective validation.
Background: For women presenting with stable chest pain (SCP), the appropriate risk assessment strategy to identify individuals unlikely to benefit from further cardiovascular imaging testing (CIT) is debatable. Thus, the present study intended to compare two risk assessment strategies in these individuals. Methods: 2592 women with SCP who underwent coronary computed tomography angiography (CCTA) were divided into low and high risk group according to 2016 National Institute of Health and Care Excellence guideline-determined strategy (NICE strategy) and 2019 European Society of Cardiology guideline-determined strategy (ESC strategy), respectively. The associations of coronary artery disease (CAD), major adverse cardiovascular event (MACE) and other subsequent clinical outcomes with risk groups and net reclassification improvement (NRI) were evaluated to compare different strategies. Results: Both NICE strategy which focused on symptom evaluation and ESC strategy which was based on pretest probability (PTP) determined by ESC-PTP model and coronary artery calcium score-weighted clinical likelihood (CACS-CL) model classified a proportion (34.49% and 63.97%, respectively) of individuals into the low risk group. Compared to NICE strategy, ESC strategy indicated stronger associations between risk groups and obstructive CAD (odds ratio: 27.63 versus 3.57), MACE (hazard ratios: 4.24 versus 1.91), more intensive clinical management as well as a positive NRI (27.71%, p < 0.0001). Conclusion: Compared to NICE strategy, ESC strategy which sequentially incorporated ESC-PTP model with CACS-CL model seemed to be associated with greater effectiveness in identifying individuals who may derive maximum benefit from further CIT in women presenting with SCP.
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Jiang et al. (2022) studied this question.
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