Can Lower-Risk Patients with Negative CCTA Be Safely Discharged from the Emergency Department?

Coronary computed tomographic angiography (CCTA) has a high negative predictive value for excluding coronary artery disease (CAD). Researchers have now assessed CCTA's value as an initial test for low-to-intermediate–risk patients (Thrombosis in Myocardial Infarction score, 0–2) without renal insufficiency who presented with chest pain to one of five emergency departments (EDs). Participants, all of whom warranted admission or further testing to rule out CAD, were randomized to CCTA (908 patients) or traditional care (462 patients).

Of the patients assigned to CCTA, 16% did not undergo it, most often because of persistently high heart rate; of the 767 who did, 83% had no significant CAD (defined as <50% stenosis). In the traditional-care gro…