How to Use CT Angiography for Chest Pain in the ED

Clinical Takeaway

: In this review, CT angiography appeared most useful in low-to-intermediate–risk patients.

Context

Coronary computed tomography angiography (CCTA) has become an important diagnostic tool for patients presenting to the emergency department with acute chest pain, but how should it be used? A new review examines the utility of CCTA in evaluating acute chest pain, especially in conjunction with initial triage using high-sensitivity troponin (hsTn) levels.

Key Points

In patients at low risk (e.g., baseline hsTn below the assay’s low cutoff and without measurable rise after 1 or 2 hours), CCTA is safe and effective in excluding obstructive coronary artery disease (CAD), allowing faster discharge with low rates of adverse events.
In high-risk patients (e.g., baseline hsTn above the assay-specific high cutoff or an absolute rise above the as…

Reviewing Author

Kirsten E. Fleischmann, M.D., M.P.H., F.A.C.C.

Disclosures

Grant/Research SupportNational Institutes of Health

Leadership Positions in Professional SocietiesAmerican College of Cardiology/American Heart Association