Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department

Gorka Bastarrika, Christian Thilo, Gary F. Headden, Peter L. Zwerner, Philip Costello, U.Joseph Schoepf

OBJECTIVE. The purpose of this article is to describe the current role of ECG-synchro-nized CT in the evaluation of patients with acute chest pain (triple rule-out) in the emergency department. We discuss clinical contexts of the chest pain algorithm, technical improvements that have enabled CT to attain its current role for this application, scan protocols and radia­tion considerations, the evidence base regarding diagnostic and prognostic performance, and initial data on the cost-effectiveness of this promising emerging test.

CONCLUSION. Currently available evidence suggests that CT-based approaches with modern scan technology are safe, accurate, and potentially cost-saving, although large-scale clin­ical trials are needed to ascertain the precise role of CT in the evaluation of acute chest pain.