The 2016 update to the NICE guideline for the investigation of new onset stable chest pain recommends use of CTCA as first line investigation in intermediate risk patients.
To compare imaging modality (CTCA and MPI) in intermediate risk diabetic and non-diabetic patients.
Retrospective review of patients referred to the rapid access chest pain clinic over a 12 month period. Individuals with intermediate risk and subsequent imaging utilised were determined. The diagnostic yield of CTCA and MPI in patients with diabetes was compared. Average Q-risk2 scores for population was calculated.
Total number of patients referred: 1376
Patients with intermediate risk: 545
Patients with diabetes: 163
Please see Table below
-Chi-squared analysis CTCA vs MPI in diabetics: Chi-squared statistic 4.87. p-value 0.03. Chi-Squared with Yates correction = 4.07 p-value 0.044
-5 of the 20 patients with positive CTCAs went on for angiography, with 3 proceeding to percutaneous coronary intervention (PCI), and 2 for coronary artery bypass grafting (CABG). 2 had further functional testing in the way of MPI.
-13 of the 35 patients with positive MPIs went on to angiography, with 7 proceeding to PCI, and 3 for CABG.
-MPI is more useful than CTCA in excluding functionally significant CAD in intermediate risk patients with diabetes.
-From our study, it is not possible to comment on which imaging modality is the best gatekeeper for invasive coronary angiography.