At least 5% of GP and accident and emergency (A&E) attendances are undifferentiated chest pain. Rapid access chest pain clinics (RACPC) offer urgent guideline-directed management of suspected cardiac chest pain. The National Institute for Health and Care Excellence (NICE) recommends computed tomography coronary angiography (CTCA) as a first-line investigation. We evaluated the effectiveness and efficiency of a local RACPC. Retrospective analysis of unselected referrals to a RACPC in the Northeast of England was conducted for 2021. Baseline demographics and major adverse cardiovascular events (MACE) were compared between typical, atypical and non-angina. Anatomical and functional imaging results were recorded. Backward stepwise binary logistic regression modelled obstructive coronary artery disease (CAD) incidence. There were 373/401 (93.0%) patients with chest pain; 139 (37.3%) typical angina, 122 (32.8%) atypical angina and 112 (30.0%) non-angina. Typical angina patients were older (p<0.001) with more cardiovascular risk factors (p<0.001) and increased risk of obstructive CAD (adjusted odds ratio [OR] 6.27, 95% confidence interval [CI] 2.93 to 13.38) and MACE (9.4%, p=0.029). In total, 164 (44.0%) had invasive coronary angiography (ICA) within 7.4 ± 4.8 weeks; 19.5% had normal coronary arteries, 26.2% had obstructive CAD and 22.6% proceeded to invasive haemodynamic assessment ± PCI without major procedural complications. There were 39 (10.5%) who had CTCA within 34.6 ± 18.1 weeks; 25.6% needed ICA to clarify diagnosis. In conclusion, typical angina patients were at heightened risk of cardiovascular events. In the absence of adequate CTCA capacity, greater reliance on ICA still facilitated accurate diagnosis with options for immediate revascularisation, timely and safely, in the right patients. Better risk stratification and expansion of non-invasive imaging can improve local RACPC service delivery in the wider Northeast cardiology network.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321461 | PMC |
| http://dx.doi.org/10.5837/bjc.2023.028 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Which Test is Best for Pain in the Chest?
R I Med J (2013)
February 2025
Professor of Medicine, Clinician Educator, Warren Alpert Medical School, Brown University; Associate Chief, Cardiology, Brown University Health Cardiovascular Institute, Providence, Rhode Island.
Chest pain is one of the most common chief complaints seen in both the emergency department (ED) and primary care settings.1,2 It is estimated that 20-40% of the general population will suffer from chest pain at some point throughout their lives.3 Interestingly although obstructive coronary artery disease (CAD) prevalence has declined, chest pain as a presenting symptom has become increasingly common over the last decade.
View Article and Find Full Text PDFAn Innovative Use of Maxillofacial Implants for the Open Reduction and Internal Fixation of a Displaced Sternal Fracture: A Case Report.
Cureus
December 2024
Oral and Maxillofacial Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN.
Sternal fractures resulting from blunt chest trauma often present unique surgical challenges. While conservative management is common, cases with significant displacement, delayed union, or painful dyspnea may require surgical intervention to improve structural stability and relieve symptoms. Here, we report the case of a 46-year-old man who sustained a displaced sternal fracture in a motor vehicle accident.
View Article and Find Full Text PDFSelective cerebral perfusion for reduced cerebral blood flow during debranching thoracic endovascular aortic repair.
J Vasc Surg Cases Innov Tech
April 2025
Department of Cardiovascular Surgery, Higashiosaka City Medical Center, Higashiosaka, Osaka, Japan.
A 69-year-old man with chest pain was diagnosed with acute type B aortic dissection with the entry tear located at distal arch and a distal aortic arch aneurysm. Therefore, we performed debranching thoracic endovascular aortic repair 2 weeks after type B aortic dissection onset. First, the graft was anastomosed to bilateral axillary arteries.
View Article and Find Full Text PDFFibromuscular Dysplasia Clinical Phenotype Manifesting as a Distal Spontaneous Coronary Artery Dissection in a Middle-Aged Man.
Cureus
January 2025
Internal Medicine, University of Florida College of Medicine, Gainesville, USA.
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease of medium-sized arteries that causes abnormal cellular growth in arterial walls and most commonly affects young to middle-aged women (20-50 years of age). While FMD often involves the renal arteries, it can affect any arterial bed. FMD has a characteristic angiographic appearance of a "string of beads.
View Article and Find Full Text PDFEndovascular management of an aortic injury in thoracic kyphosis surgery: a minimally invasive rescue for a life-threatening injury.
BMJ Case Rep
January 2025
Department of Orthopaedics and Spine Surgery, Military Hospital Khadki, Pune, Maharashtra, India.
A patient in his early adolescence, who was treated for T5-T6 tubercular spondylodiscitis with an un-instrumented decompression, presented at 36 months post-index surgery, for post-laminectomy instability and kyphosis, after completing his requisite antitubercular treatment. He underwent thoracic posterior instrumented kyphosis correction and anterior reconstruction, with a T5-T6 partial corpectomy and corpectomy spacer placement, through a posterior midline incision. On the second postoperative day, he started complaining of pain on the left side of his chest, abdomen and left shoulder.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!