Open AccessDebates over NICE Guideline Update: What Are the Roles of Nuclear Cardiology in the Initial Evaluation of Stable Chest Pain?
Author(s) -
Sang-Geon Cho,
Jahae Kim,
HoChun Song
Publication year - 2019
Publication title -
nuclear medicine and molecular imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.534
H-Index - 23
eISSN - 1869-3482
pISSN - 1869-3474
DOI - 10.1007/s13139-019-00607-9
Subject(s) - medicine , nice , myocardial perfusion imaging , chest pain , coronary artery disease , guideline , cardiac imaging , excellence , radiology , cardiology , pathology , computer science , political science , law , programming language
Recent clinical trials have demonstrated the values of cardiac computed tomography (CT) in the initial evaluation of stable chest pain which led to drastic changes in the National Institute for Health and Care Excellence (NICE) guidelines in 2016. According to the updated NICE guidelines, cardiac CT should be performed as the initial cardiac testing in stable chest pain regardless of pre-test probability (PTP) of coronary artery disease (CAD). As a result, cardiac CT is now considered as a validated gatekeeper for assessing stable chest pain, which precedes all the functional studies including nuclear myocardial perfusion imaging (MPI). Nuclear MPI, in contrast, has been assigned as one of the second-line studies, which is inevitably dependent on the results of cardiac CT. However, nuclear MPI has genuine values in the diagnosis, treatment decision, and prognostic stratification of stable chest pain, which cannot be replaced by cardiac CT. In this review, the updated NICE guidelines and related cardiac CT trials will be critically reviewed from the view of nuclear physicians and the exceptional values of nuclear MPI will be described along with the future perspectives.