Why the study?
NICE guidelines position coronary computed tomography angiography as the first test for stable chest pain without confirmed coronary artery disease, whereas ACCF/AHA and ESC guidelines maintain functional stress testing as the tests of choice.
Does coronary computed tomography angiography as a first-line test improve evaluation of stable coronary disease compared to stress testing functional modalities?
Does coronary computed tomography angiography as a first-line test improve evaluation of stable coronary disease compared to stress testing functional modalities?
This debate highlights the paradigm shift in the 2016 NICE guidelines recommending CCTA as the first-line test for stable chest pain, contrasting with ACCF/AHA and ESC guidelines that favor functional stress testing.
NICE 2016 CT-first strategy for stable chest pain warrants prospective validation; leaves open superiority over likelihood-based approaches endorsed elsewhere.
The 2016 National Institute of Health and Care Excellence clinical guideline for the assessment and diagnosis of chest pain positions coronary computed tomography angiography as the first test for all stable chest pain patients without confirmed coronary artery disease and discards the previous emphasis on calculation of pre-test likelihood recommended in their 2012 edition of the guidelines. On the other hand, the American College of Cardiology Foundation/American Heart Association and the European Society of Cardiology guidelines continue to present the stress testing functional modalities as the tests of choice. The aim of this review is to present, in the form of a debate, the pros and cons of these paradigm changing recommendations, with an emphasis on literature review and projection of future needs, with conclusions to be drawn by the reader.
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Hecht et al. (2019) studied this question.
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