Multislice CT for Evaluation of Acute Chest Pain in the ED?

Evaluation with MSCT was initially faster and cheaper than nuclear stress testing but resulted in a higher rate of invasive angiography, with unclear additional clinical benefit.

How should we initially evaluate low-risk patients with acute chest pain? In this randomized study, researchers compared a strategy using multislice computed tomography (MSCT) —followed by nuclear stress testing if MSCT results were equivocal — with a standard diagnostic approach of nuclear stress testing. Patients with symptoms of ischemia within 12 hours of presentation and a low risk for infarction or complications were eligible; patients with known coronary artery disease or cardiomyopathy, diagnostic electrocardiographic changes, elevated biomarkers, or contraindications to the imaging protocol were excluded. Angiography was recommended in patients with >70% stenosis or abnormal nuclear scans.

Of 99 patients randomized to initial MSCT, …

Reviewing Author

Kirsten E. Fleischmann, MD, MPH