Open heart · 2026
Direct access CT coronary angiography in patients referred with suspected cardiac chest pain: a novel patient pathway.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ahmad Faheem, Galvin Jessica, Cruickshanks Wendy, Miller Laura, Hunter Andrew, Murdoch David, Campbell Ross T, Connolly Eugene, Mangion Kenneth
Аннотация
BACKGROUND: Rapid access chest pain (RACP) clinics are designed to expedite cardiac assessment, but current pathways cause delays due to sequential consultations and testing. This pilot evaluated a novel direct-to-CT coronary angiography (CTCA) pathway to test the hypothesis that a 'test-first' model would reduce the time to diagnosis and clinic utilisation.
METHODS: This was a prospective single-centre pilot of consecutive primary care referrals to an RACP service (June 2024-January 2025). Eligible patients with suspected anginal symptoms, no known coronary artery disease (CAD) and no contraindications to CTCA were offered an opt-in to a direct-to-CTCA pathway. CTCA was performed using a prospective single-heartbeat acquisition. The primary outcome was referral-to-diagnosis interval. Secondary outcomes included need for face-to-face consultation, further investigations, incidental findings and theoretical cost savings.
RESULTS: 149 patients (mean age 57±9 years, 34% female) underwent CTCA. Median referral-to-diagnosis interval was 29 days (IQR 21-41) vs 88 days (IQR 84-101) in the conventional pathway. CTCA revealed no or mild CAD in 104 (70%) patients; only 47 (32%) required subsequent face-to-face review. Follow-up testing included exercise ECG (17%), echocardiography (8%) and invasive coronary angiography (7%). Incidental findings were uncovered in 30%, with 3% leading to specialty referral. An estimated 102 outpatient visits were avoided, with a cost avoidance estimate of £32 620 per year.
CONCLUSIONS: A direct-to-CTCA pathway for patients with suspected cardiac chest pain is feasible, reduces time to diagnosis and aligns with National Institute for Health and Care Excellence guidelines. The pathway enables early CAD exclusion in most patients, reduces unnecessary clinic visits and optimises resource use without compromising diagnostic quality.
METHODS: This was a prospective single-centre pilot of consecutive primary care referrals to an RACP service (June 2024-January 2025). Eligible patients with suspected anginal symptoms, no known coronary artery disease (CAD) and no contraindications to CTCA were offered an opt-in to a direct-to-CTCA pathway. CTCA was performed using a prospective single-heartbeat acquisition. The primary outcome was referral-to-diagnosis interval. Secondary outcomes included need for face-to-face consultation, further investigations, incidental findings and theoretical cost savings.
RESULTS: 149 patients (mean age 57±9 years, 34% female) underwent CTCA. Median referral-to-diagnosis interval was 29 days (IQR 21-41) vs 88 days (IQR 84-101) in the conventional pathway. CTCA revealed no or mild CAD in 104 (70%) patients; only 47 (32%) required subsequent face-to-face review. Follow-up testing included exercise ECG (17%), echocardiography (8%) and invasive coronary angiography (7%). Incidental findings were uncovered in 30%, with 3% leading to specialty referral. An estimated 102 outpatient visits were avoided, with a cost avoidance estimate of £32 620 per year.
CONCLUSIONS: A direct-to-CTCA pathway for patients with suspected cardiac chest pain is feasible, reduces time to diagnosis and aligns with National Institute for Health and Care Excellence guidelines. The pathway enables early CAD exclusion in most patients, reduces unnecessary clinic visits and optimises resource use without compromising diagnostic quality.