Investigation of patients presenting with chest pain

摘要

The paper by Patterson et al illustrates why the National Institute of Health and Care Excellence (NICE) and ESC guidelines recommend no non-invasive testing in patients presenting with undifferentiated chest pain in whom a non-cardiac cause is suspected or the probability of coronary artery disease (CAD) is judged to be very low (NICE ＜10%, ESC ＜15%). Table 5 shows there were 351 such patients, of whom 24 were subsequently diagnosed with CAD. Even if we accept that the chest pain in all 24 of these 'false-negative' cases was in fact caused by myocardial ischaemia, this is equivalent to a diagnostic sensitivity of 93% for clinical judgement in ruling out coronary disease, better than could be achieved by exercise electrocardiography or perfusion imaging in such a low-risk population.