Open AccessOld and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective
Author(s) -
Nazario Carrabba,
Angela Migliorini,
Silvia Pradella,
Manlio Acquafresca,
Marco Guglielmo,
Andrea Baggiano,
Giuseppe Moscogiuri,
Renato Valenti
Publication year - 2018
Publication title -
biomed research international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 126
eISSN - 2314-6141
pISSN - 2314-6133
DOI - 10.1155/2018/3762305
Subject(s) - nice , guideline , chest pain , medicine , coronary artery disease , pre and post test probability , excellence , intensive care medicine , radiology , pathology , programming language , computer science , political science , law
Stable chest pain is a common clinical presentation that often requires further investigation using noninvasive or invasive testing, resulting in a resource-consuming problem worldwide. At onset of 2016, the National Institute for Health and Care Excellence (NICE) published an update on its guideline on chest pain. Three key changes to the 2010 version were provided by the new NICE guideline. First, the new guideline recommends that the previously proposed pretest probability risk score should no longer be used. Second, they also recommend that a calcium score of zero should no longer be used to rule out coronary artery disease (CAD) in patients with low pretest probability. Third, the new guideline recommends that all patients with new onset chest pain should be investigated with a coronary computed tomographic angiography (CTA) as a first-line investigation. However, in real world the impact of implementation of CTA for the evaluation of new onset chest pain remains to be evaluated, especially regarding its cost effectiveness. The aim of the present report was to discuss the results of the studies supporting new NICE guideline and its comparison with European and US guidelines.