Coronary CT Angiography in the Emergency Department: Current Status

In the United States alone, nearly 7 million patients present annually to emergency departments (ED) with complaints of chest pain suspicious for acute coronary ischemia. Acute chest pain represents a clinical as well as economic challenge, resulting in elaborate, time-consuming, and expensive work-ups to avoid litigation related to missed diagnoses of acute coronary syndromes (ACS). Coronary CT angiography (CTA) is an attractive noninvasive technique with promising data for use in the ED due to its high accuracy and negative predictive value. Recent studies have demonstrated that coronary CTA can aid in safe, rapid, and cost-efficient triage of patients with acute chest pain. Additional applications of plaque characterization, fractional flow analysis, and CT perfusion imaging hold promise in providing incremental data in patients with suspected ACS.