Authors

• Diana Rudan — Klinička bolnica Dubrava, Zagreb, Hrvatska
• Hrvojka Marija Zeljko — St Helens and Knowsley Teaching Hospitals NHS Trust, Precot, Ujedinjeno Kraljevstvo

Abstract

**Introduction:** Chest pain is the most frequent symptom of coronary artery disease (CAD). Previous systematic review including 31 countries found average weighted prevalence of angina in males to be 5.7% and 6.7% in women. (1) In primary care the prevalence of patients presenting with chest pain that ultimately have CAD, is even lower, estimated to be around 1-2%. (2) Not every chest pain is associated with CAD, and physicians are using various methods to predict and diagnose CAD in patients with chest pain. Cardiology practice in the UK is guided by the use of National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) Guidelines. Cardiologists in Europe guide their decisions according to ESC guidelines. This review is comparing scientific background for differences between most recent NICE and ESC guidelines in the diagnostic of chest pain and stable CAD that guide physician’s decision making in daily clinical practice. **Comparison of Guidelines:** In 2010 NICE published guidelines for diagnosis, and in 2011 for management of stable CAD. In November 2016, NICE published update of those guidelines. (3) This update consist of two important changes considering the use of pre-test probability assessment, and introduction of wide use of cardiac CT in the diagnosis of CAD. The last ESC guidelines for diagnosis and management of stable CAD were published in 2013. ESC Guidelines combined both CAD diagnostic and management guidelines. Statements are given according to the class of recommendation and level of evidence. This form of guidance is not applied in NICE, where rather simple statements are used. ESC guidelines do not assess cost-effectiveness of the recommendation, as opposed to the NICE Guidelines. **Conclusion:** Differences exist between NICE and ESC guidelines affecting clinical practice in approaching diagnostic of chest pain and stable CAD. The ESC pathway for diagnosis of chest pain is based on the functional/stress imaging, that can be replaced with exercise ECG if stress imaging facilities are not locally available. On the other hand, NICE guidelines moved away from exercise ECG, first towards more accurate functional stress imaging modalities, and later, according to the last update from 2016, towards 64-slice CT coronary angiography as a first line imaging modality.

Keywords

coronary artery disease, chest pain, guidelines

DOI

Literature

1. Hemingway H, Langenberg C, Damant J, Frost C, Pyörälä K, Barrett-Connor E. Prevalence of angina in women versus men: a systematic review and meta-analysis of international variations across 31 countries. Circulation. 2008 Mar 25;117(12):1526–36. https://doi.org/10.1161/CIRCULATIONAHA.107.720953
2. Ruigómez A, Rodríguez LAG, Wallander MA, Johansson S, Jones R. Chest pain in general practice: incidence, comorbidity and mortality. Fam Pract. 2006 Apr;23(2):167–74. https://doi.org/10.1093/fampra/cmi124
3. National Institute for Health and Care Excellence Guidelines. Chest pain of recent onset: assessment and diagnosis Clinical guideline [CG95]. Published date: March 2010. Last updated: November 2016. Available from: (October 10, 2018). https://www.nice.org.uk/guidance/cg95