Newer imaging methods for triaging patients presenting to the emergency department with chest pain

Area of Science:

• Cardiology
• Radiology
• Emergency Medicine

Background:

• Acute coronary syndrome (ACS) is a common emergency department (ED) presentation.
• Risk stratification is crucial for managing patients with possible ACS.
• Electron beam CT (EBCT) has emerged as a potential tool for cardiac risk assessment.

Purpose of the Study:

• To evaluate the utility of EBCT in risk stratification of ED patients with possible ACS.
• To assess the diagnostic performance of EBCT in identifying patients at low risk for adverse cardiac events.

Main Methods:

• Review of three small studies evaluating EBCT in the ED setting.
• Analysis of coronary calcium detection by EBCT and subsequent cardiac event rates.
• Assessment of the positive and negative predictive values of EBCT.

Main Results:

• Patients with no detectable coronary calcium on EBCT experienced virtually no adverse cardiac events.
• EBCT demonstrated excellent negative predictive value for ACS.
• The positive predictive value of EBCT was limited, potentially leading to unnecessary further testing.

Conclusions:

• EBCT is a promising tool for ruling out ACS in specific ED populations.
• Further large-scale studies are needed to define EBCT's role in evaluating chest pain patients with nondiagnostic ECGs.
• Multislice CT angiography shows potential but requires further clinical validation for ED use.