Computed Tomography Coronary Angiography Versus Stress Echocardiography in a Rapid Access Chest Pain Clinic

Outpatient rapid-access chest pain clinics (RACPCs) investigate and manage low-to intermediate-risk chest pain. Several non-invasive investigations have been employed for RACPCs, including stress echocardiography (SE) and computed tomography coronary angiography (CTCA). However, research on the influence of these tests on diagnosis and management in this setting is limited. This study aimed to determine whether patients who underwent CTCA differed in their risk profile, diagnosis, and management compared to those who underwent SE in RACPC.

This retrospective single-centre observational study included 903 patients who presented to the RACPC with low-to-intermediate-risk chest pain. Patients were investigated using SE and/or CTCA at the discretion of the treating cardiologist.

Overall, 68.4% of the patients were initially investigated using SE vs CTCA. Individuals with cardiac risk factors, including male patients and those using lipid-lowering agents before the RACPC review, were more likely to be initially investigated with CTCA. Patients who underwent CTCA at any point during their clinic visit had higher rates of invasive angiography, coronary intervention, and cardiac specialist referral than those who underwent SE alone. Patients who received CTCA at any time had higher prescription rates of antiplatelet, antihypertensive, and lipid-lowering medications, irrespective of whether they underwent invasive angiography, compared to the SE-only group.

SE remains a popular initial screening method for patients with RACPC with low-to-intermediate-risk profiles. More men had CTCA, and more women had SE in their initial investigation. Patients investigated using a CTCA strategy were more likely to undergo invasive coronary angiography, procedural intervention, and the initiation of antiplatelet, antihypertensive, and lipid-lowering medications.