{
  "abstract": "Introduction A significant proportion of non-ST-segment elevation myocardial infarction (NSTEMI) cases are found to have non-obstructive coronary artery disease during invasive coronary angiography (ICA). Emerging evidence suggests that early upstream use of non-invasive cardiac imaging in selected patients may enhance diagnostic precision, reduce unnecessary ICA, and better inform downstream management. 1–4 Patient acceptability of a non-invasive first approach has not been formally evaluated. Such a strategy can be hypothesised to alleviate anxiety during prolonged waits for invasive procedures by instead tailoring investigations to individual patient risk.Methods Between July and December 2020, we conducted a single-centre survey of 200 patients with NSTEMI (100 inpatients and 100 outpatient day cases) immediately prior to ICA. The survey assessed eligibility for coronary computed tomography angiography (CCTA) or cardiac magnetic resonance imaging (CMR), patient attitudes towards ICA, and willingness to adopt a non-invasive first strategy. Clinical outcomes – including anxiety, symptom recurrence, timing of ICA, and angiographic findings – were obtained from electronic patient records.Results Eligibility for both CCTA (92%) and CMR (75%) was high ( table 1). Reasons for ineligibility included claustrophobia (10%), inability to lie flat for prolonged periods (8%), and chronic kidney disease (5%). Overall, 96% of patients expressed a preference for CCTA or CMR prior to ICA, and 81% indicated they would be willing to forgo ICA if non-invasive results were reassuring. This suggests little to no pre-existing bias in favour of an invasive first approach. The median time from referral to ICA was 5 days for inpatients and 47.5 days for outpatients (table 2). Non-obstructive coronary arteries were identified in 26% of inpatients and 39% of outpatients, suggesting that a non-invasive first strategy may significantly reduce unnecessary invasive procedures in this cohort. Eighty-five (43%) patients reported anxiety while awaiting ICA; of these, 28 (33%) had unobstructed coronaries. Recurrent symptoms while waiting for ICA were reported in 117 (59%) patients; of these, 33 (28%) were found to have unobstructed coronaries. This raises the possibility that anxiety may contribute to symptom reporting among those without obstructive coronary disease, and that earlier diagnostic reassurance via a non-invasive first approach could reduce recurrent presentations.Conclusions Most patients in our low-risk NSTEMI cohort were eligible for a non-invasive first approach, which was also preferred by the majority over ICA. Given the substantial proportion found to have non-obstructive coronary arteries, such a strategy may reduce procedural volumes and help mitigate symptom-related anxiety during waits for ICA. These findings support multicentre evaluation of a standardised CCTA/CMR-first pathway for low-risk NSTEMI patients.Abstract 295 Table 1Patient preferences and eligibility for cardiac imaging. CCTA, coronary computed tomography angiography; CMR, cardiac magnetic resonance imaging; ICA, invasive coronary angiography; eGFR, estimated glomerular filtration ratePatient preferences and eligibility for cardiac imagingInpatient (n = 100)Outpatient (n = 100)Willing to undergo CCTA or CMR prior to ICA, n (%)96 (96)95 (95)Willing to forgo ICA if CCTA or CMR is reassuring, n (%)76 (76)86 (86)Eligible for CMR, n (%)70 (70)79 (79)Eligible for CCTA, n (%)89 (89)94 (94)Reasons for ineligibility for cardiac imaging: Claustrophobia, n (%)12 (12)8 (8)Unable to lie flat for >30 minutes, n (%)6 (6)9 (9)eGFR <30 mL/min/1.73m2, n (%)6 (6)3 (3)Others (contrast allergy, pacemaker), n (%)6 (6)3 (3)Abstract 295 Table 2Patient demographics, experience, and outcomes. SD, standard deviation; IQR, interquartile range; ICA, invasive coronary angiography; LMS, left main stem; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graftPatient demographics, experience, and outcomesInpatient (n = 100)Outpatient (n = 100)Age, years, mean (SD)65 (10.5)64.5 (8.1)Male, n (%)68 (68)72 (72)Anxiety while awaiting ICA, n (%)48 (48)37 (37)Recurrence of symptoms while awaiting ICA, n (%)58 (58)59 (59)Readmission or re-referral while awaiting ICA, n (%)27 (27)14 (14)Time from referral to ICA, days, median (IQR)5 (4.3)47.5 (37.3)Non-obstructive coronaries, n (%)26 (26)39 (39)LMS disease, n (%)11 (11)9 (9)PCI/CABG, n (%)74 (74)61 (61)",
  "authors": [
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom"
      ],
      "name": "Yen Wing Ng"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom"
      ],
      "name": "Andrew Apps"
    },
    {
      "affiliations": [
        "University of Glasgow, Glasgow, United Kingdom"
      ],
      "name": "James Connelly"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom"
      ],
      "name": "Hamish Elliott"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom"
      ],
      "name": "Shaun Leonard"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom"
      ],
      "name": "Aisha Gohar"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom"
      ],
      "name": "Evangelos Tzolos"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, United Kingdom",
        "University of Glasgow, Glasgow, United Kingdom"
      ],
      "name": "Colin Berry"
    }
  ],
  "title": "295 Exploring patient preferences and the potential clinical impact of a non-invasive first strategy in a low-risk NSTEMI cohort",
  "uid": "767373da-f1cd-57b4-ae87-ef0c6420c439"
}