Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study

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.