Optimal Evaluation of Stable Chest Pain to Reduce Unnecessary Cardiac Imaging Comparing 2016 NICE and 2019 ESC Diagnostic Strategies for Chronic Coronary Syndrome

What this Trial Is About

Researchers are evaluating two diagnostic strategies to manage new or stable chest pain that may indicate chronic coronary syndrome (CCS). This trial aims to identify patients at low risk who might not benefit from further cardiac imaging tests, specifically coronary computed tomography angiography (CCTA). The OPERATE study is a pragmatic randomized controlled trial designed to compare the effectiveness and safety of these strategies in routine clinical practice, addressing the challenge of reducing unnecessary imaging. The study randomly assigns about 800 participants with stable chest pain suggestive of CCS into two groups. One group follows the 2016 NICE guideline strategy, which classifies patients by chest pain type and ECG results to decide if CCTA is needed. The other group follows the 2019 ESC guideline strategy, which uses calculated risk scores based on age, sex, chest pain type, and cardiovascular risk factors to determine who should undergo CCTA. Patients considered low risk under either strategy receive optimal medical treatment without immediate imaging. Participants will be monitored through their initial management period, averaging 2 to 5 days, to determine the rate of CCTA without obstructive coronary artery disease. The trial also assesses major adverse cardiac events over a one-year follow-up to ensure safety. Throughout the study, data on imaging results, clinical events, and treatment adherence will be collected to compare the diagnostic strategies' impact on patient care and resource use.

Optimal Evaluation to Reduce Cardiovascular Imaging Testing