CT Angiography in the ED — A Better Test for Patients with Chest Pain?

Computed tomographic angiography (CTA) to rule out coronary artery disease (CAD) is increasing in popularity. In two studies in 2012, investigators examined its use in emergency department (ED) patients who presented with chest pain but without clear-cut electrocardiographic or enzymatic evidence of ischemia.

In one analysis, 1370 relatively low-risk patients with no substantial renal insufficiency who warranted admission or further testing were randomized to CTA or “traditional care” at five U.S. EDs; 160f patients who were randomized to CTA did not undergo the test, most commonly because of high heart rate. Of those who did undergo CTA, 83 0id not exhibit substantial CAD (defined as >50tenosis). In the control group, 640f patients underwen…