Testing Strategies to Rule Out Acute Coronary Syndromes: Which Is Most Efficient?

Advances in technology have expanded the choices available for evaluating patients with acute chest pain but have also generated much controversy about the ideal testing strategy. In the ROMICAT-II trial, sponsored by the National Heart, Lung, and Blood Institute, investigators compared a strategy of early contrast-enhanced coronary computed tomographic angiography (CCTA) with standard emergency-department evaluation of adults with a suspected acute coronary syndrome (ACS) with respect to length of hospital stay, subsequent testing, cost, and radiation exposure.

Of 1273 patients assessed for eligibility, 1000 were randomized (mean age, 54; almost 50% women). Average hospital stay was 7.6 hours shorter in the CCTA group than in the standard-c…