Key result
NICE risk score directs 44% of chest pain patients to invasive angiography versus 0.3% with ESC.
Why the study?
There is uncertainty about how different pre-test probability risk scores from UK NICE and ESC guidelines affect the investigation of patients with stable chest pain.
Does the NICE 2010 guideline pre-test probability risk score compared to the ESC 2013 guideline alter the rate of recommended invasive coronary angiography in patients with stable chest pain?
Cohort
No
Does the NICE 2010 guideline pre-test probability risk score compared to the ESC 2013 guideline alter the rate of recommended invasive coronary angiography in patients with stable chest pain?
Absolute Event Rate: 44% vs 0.3%
The NICE 2010 guidelines significantly overestimate the risk of stable chest pain compared to ESC 2013 guidelines, leading to a massive over-recommendation of invasive coronary angiography (44% vs 0.3%).
OBJECTIVES: To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. DESIGN: We undertook a large retrospective study to investigate the outcomes of stress echocardiography. SETTING: A large tertiary centre in the UK in a contemporary clinical practice. PARTICIPANTS: Two thirds of the patients in the cohort were referred from our rapid access chest pain clinics. RESULTS: We found that the NICE risk score overestimates risk by 20% compared to the ESC Risk score. We also found that based on the NICE guidelines, 44% of the patients presenting with chest pain, in this cohort, would have been investigated invasively, with diagnostic coronary angiography. Using the ESC guidelines, only 0.3% of the patients would be investigated invasively. CONCLUSION: The large discrepancy between the two guidelines can be easily reduced if NICE adopted the ESC risk score.
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Demarco et al. (2015) conducted a cohort in stable chest pain. NICE guideline (2010) risk score vs. ESC guideline (2013) risk score was evaluated on proportion of patients investigated invasively with diagnostic coronary angiography. The NICE risk score overestimates risk by 20% compared to the ESC risk score, leading to 44% of chest pain patients being investigated invasively versus 0.3% with the ESC guidelines.
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