Cardiac CT in the emergency department

Area of Science:

• Cardiology
• Emergency Medicine
• Radiology

Background:

• Millions of emergency department visits annually are due to chest pain, often suggestive of acute coronary ischemia.
• A significant portion of these patients undergo extensive evaluation for acute coronary syndrome (ACS), with less than 30% ultimately diagnosed with ACS.
• Accurate risk stratification is crucial for efficient emergency department workflow and patient management.

Purpose of the Study:

• To review the utility of computed tomography (CT) in evaluating patients presenting with acute chest pain in the emergency department.
• To highlight the role of cardiac CT in ruling out coronary artery disease (CAD) in specific patient populations.

Main Methods:

• Review of current literature and guidelines regarding the application of CT for acute chest pain evaluation.
• Focus on the performance of cardiac CT in patients with low to intermediate probability of ACS.
• Discussion of the 'appropriate' use of cardiac CT as defined by major cardiology guidelines.

Main Results:

• Cardiac CT demonstrates strong performance in ruling out coronary artery disease in patients with low to intermediate pre-test probability.
• The American College of Cardiology and American Heart Association recognize cardiac CT as an appropriate imaging modality for this indication.
• CT imaging can help differentiate causes of chest pain, potentially reducing unnecessary admissions and invasive procedures.

Conclusions:

• Cardiac CT is a valuable tool for the emergency department evaluation of acute chest pain, particularly in patients unlikely to have ACS.
• Its high negative predictive value aids in safely excluding coronary artery disease, optimizing patient care and resource utilization.
• The appropriate application of CT aligns with current clinical guidelines for managing patients with suspected cardiac ischemia.