• Research type

    Research Study

  • Full title

    A pragmatic approach to the investigation of stable chest pain: a UK, multi-centre, randomised trial to improve patient experience, outcomes and NHS cost efficiency



  • Contact name

    John Greenwood

  • Contact email


  • Sponsor organisation

    University of Leeds

  • ISRCTN Number


  • Duration of Study in the UK

    4 years, 11 months, 30 days

  • Research summary

    This trial will look at patients who present with new onset chest pain that is possibly caused by the heart arteries narrowing. The research will try to find out what the best first (non-invasive) test is for such patients. We will do that by looking at how many patients go on to have further (invasive) tests, in particular a test called an x-ray coronary angiogram (XCA), and how many of these turned out to be ‘unnecessary’, in other words it showed the heart arteries to be normal.

    The main question we are hoping to answer is whether functional tests are better than anatomical tests, or whether either strategy is equally effective. In functional tests we look at how well the heart is pumping and what happens when it has to work harder than normal. In anatomical tests we look whether there are any narrowing in the heart arteries. At the moment we do not know which tests are better for patients and different guidelines make very different recommendations.

    We already know that functional tests, when done as a first test in a patient with new chest pain (following ESC guidelines), can make the number of unnecessary invasive angiograms lower than if we follow the previous (2010) national (NICE) guidelines. We now have new NICE guidelines (2016) that advise doing anatomical tests as a first test. We hope to be able to show whether this is a good idea or not.

    We know from previous studies we have done (CE-MARC and CE-MARC 2) that most people with cardiovascular disease are keen to avoid invasive angiograms if possible. If we can find a safe way to reduce the number of these that will be good for patients and also for the purse strings of the NHS.

  • REC name

    London - London Bridge Research Ethics Committee

  • REC reference


  • Date of REC Opinion

    1 Oct 2021

  • REC opinion

    Further Information Favourable Opinion

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