Multidetector CT as a Diagnostic Tool for Chest Pain Evaluation

The initial approach to emergency department patients with chest pain varies and often consumes much time and resources. Current practice usually involves use of biomarkers and provocative testing, such as a graded exercise tolerance test, to determine which patients might warrant invasive angiography. However, computed tomography (CT) technology has evolved to allow noninvasive imaging of the coronary vasculature. In a Korean study, researchers assessed the role of multidetector CT (MDCT) in the ED evaluation of chest pain.

Researchers prospectively enrolled 268 patients who presented to a single ED and were categorized as having high-, intermediate-, or low-probability risk for acute coronary syndromes based on history, physical exam, and electrocardiogram findings; another 248 patients who were categorized as having very high or very low risk were excluded. Eligible patients were randomized to either MDCT imaging or a conventional diagnostic strategy that included biomarker measurement and functional testing. Subsequent diagnostic studies, treatment, and disposition decisions were at the discretion of the treating physician. The MDCT group had a significantly shorter hospital stay than the placebo group (mean, 7.1 vs. 26.6 hours) and significantly fewer admissions that were subsequently deemed “unnecessary” by an expert consensus panel (4% vs. 15%). Length of ED stay did not differ statistically between groups (4.6 vs. 4.8 hours, respectively). None of the MDCT patients who were discharged from the ED experienced major cardiac events during 1-month follow-up.