Key result
NICE guidelines recommend CT coronary angiography as first-line investigation for new-onset chest pain.
Why the study?
The 2016 update to the NICE guideline for investigating new onset stable chest pain introduced key changes including abandoning previous risk scores and recommending CT coronary angiogram as first-line investigation.
The 2016 NICE guideline update represents a radical shift in the investigation of stable chest pain, prioritizing CT coronary angiography for all patients.
Adopts CTCA as first-line for new chest pain; extends RCT evidence into routine guidelines.
The National Institute for Health and Care Excellence (NICE) published an update on its guideline on chest pain of recent onset in 2016. The new guideline makes three key changes to the 2010 version. NICE recommend that the previously proposed pre-test probability risk score should no longer be used. They also recommend that a calcium score of zero should no longer be used to rule out coronary artery disease in patients with low pre-test probability. However, the most radical change is that NICE now recommend that all patients with new onset chest pain should be investigated with a computerised tomography coronary angiogram as a first-ine investigation. We discuss the recent trial evidence that has informed the NICE update and consider the impact of the new guidelines.
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Alfakih et al. (2017) conducted a review in New onset stable chest pain. Computerised tomography coronary angiogram vs. Previous guideline recommendations was evaluated. The 2016 NICE guideline update recommends computerised tomography coronary angiogram as a first-line investigation for all patients with new onset chest pain.
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