Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
CTCA for stable chest pain is not a substitute for the acute STEMI or high-risk NSTE-ACS pathway. New rest pain, dynamic ECG change or instability requires emergency assessment.
Synopsis
Use CT coronary angiography as the UK first-line anatomical test for appropriate stable chest pain and interpret stenosis, plaque and calcium without false reassurance.
NICE CG95 recommends 64-slice-or-above CTCA first-line when assessment indicates typical or atypical angina.
CTCA visualises lumen and plaque; a calcium score quantifies calcified plaque but does not show stenosis or non-calcified plaque.
NICE no longer uses stand-alone coronary calcium scoring to diagnose stable angina.
Key red flags
Contrast reaction
Bronchospasm, facial or laryngeal swelling, hypotension or collapse after contrast requires an immediate emergency response.
Investigation priorities
01
CT coronary angiographyFirst step
Exclude or define anatomical coronary disease in stable suspected angina.
Management branches
Preferred routeStable suspected angina
Typical or atypical angina without acute features
Complete clinical assessment, resting ECG and baseline safety checks.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.