Abstract
This review article provides an overview regarding the role of computed tomography (CT) in the evaluation of acute chest pain (ACP) in the emergency department (ED), focusing on characteristic CT findings.
Highlights
Lee, H.Y.; Song, I.S.; Chun, E.J.; White, Acute chest pain (ACP) is the second most common presentation in the emergency department (ED) [1]
The ROMICAT II and ACRIN trials reported very high negative predictive values for coronary CTA in excluding > 50% coronary stenosis in ED settings, demonstrating that this approach can lead to a more rapid and safer discharge from the ED (47% vs. 12%, p < 0.001, and 49.6% vs. 22.7%, p < 0.001, respectively), a shorter the ED stay (8.6 h vs. 26.7 h, p < 0.001, and 18.0 h vs. 24.8 h, p < 0.001, respectively), and improved ED cost-effectiveness compared to the standard assessment [7,8]
According to a meta-analysis of the outcomes of randomized controlled trials of coronary CTA in the ED, the use of coronary CTA was associated with decreased ED cost and length of stay but increased rates of coronary angiography and revascularization [11]
Summary
In patients with a high risk of ACS, prompt invasive coronary angiography and/or revascularization should be performed without noninvasive imaging in order to salvage viable myocardium. ECGs, and cardiac troponins, followed by optional functional testing (i.e., exercise ECG, rest and/or stress perfusion imaging, or stress echocardiography) [2,3]. This standard protocol may be associated with a lengthy stay in the ED or coronary care unit awaiting. There may be uncertainty among ED physicians and cardiologists regarding the best option (i.e., anatomic (CT) versus hs-Tn with functional testing) for evaluating ED chest pain [6].
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