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Review
. 2017;10(5):15.
doi: 10.1007/s12410-017-9412-6. Epub 2017 Mar 27.

The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease

Alastair J Moss  1 , Michelle C Williams  1 , David E Newby  1 , Edward D Nicol  2
Affiliations
Review

The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease

Alastair J Moss et al. Curr Cardiovasc Imaging Rep. 2017.

Abstract

Purpose of review: Cost-effective care pathways are integral to delivering sustainable healthcare programmes. Due to the overestimation of coronary artery disease using traditional risk tables, non-invasive testing has been utilised to improve risk stratification and initiate appropriate management to reduce the dependence on invasive investigations. In line with recent technological improvements, cardiac CT is a modality that offers a detailed anatomical assessment of coronary artery disease comparable to invasive coronary angiography.

Recent findings: The recent publication of the National Institute for Health and Care Excellences (NICE) Clinical Guideline 95 update assesses the performance and cost utility of different non-invasive imaging strategies in patients presenting with suspected anginal chest pain. The low cost and high sensitivity of cardiac CT makes it the non-invasive test of choice in the evaluation of stable angina. This has now been ratified in national guidelines with NICE recommending cardiac CT as the first-line investigation for all patients presenting with chest pain due to suspected coronary artery disease. Additionally, randomised controlled trials have demonstrated that cardiac CT improves diagnostic certainty when incorporated into chest pain pathways.

Summary: NICE recommend cardiac CT as the first-line test for the evaluation of stable coronary artery disease in chest pain pathways.

Keywords: Angina; Chest pain; Coronary artery disease; Coronary computed tomography angiography.

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Conflict of interest statement

Conflict of Interest

David E. Newby reports grants and personal fees from Toshiba, during the conduct of study.

The other authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
NICE cost-effectiveness analysis of diagnostic tests in 45% pre-test likelihood population. [14]. The figure plots the average proportion of correct diagnoses (effectiveness) versus the average cost (£ sterling) of each testing strategy. A first-line testing strategy using CT coronary angiography has the lowest cost per correct diagnosis of coronary artery disease. The cost-effectiveness frontier is represented by a line connecting no testing, CT coronary angiography, and invasive coronary angiography. All other testing strategies lie beneath this line and have fewer correct diagnoses at a higher cost
See this image and copyright information in PMC

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