Coronary computed tomographic angiography in the emergency room: state of the art
Michael K Cheezum1, Marcio S Bittencourt, Edward A Hulten
1Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Non-Invasive Cardiovascular Imaging Program, Boston, MA, USA.
Insights
Coronary computed tomographic angiography (CTA) offers a highly sensitive and efficient alternative for evaluating acute chest pain, rapidly identifying patients without obstructive coronary artery disease and reducing major adverse cardiac events.
Area of Science:
- Cardiology
- Radiology
- Emergency Medicine
Background:
- Chest pain is a frequent emergency department complaint requiring evaluation for obstructive coronary artery disease.
- Traditional diagnostic methods (ECG, biomarkers, stress testing) can be costly and inefficient.
- Coronary computed tomographic angiography (CTA) presents a high-sensitivity alternative for diagnosing coronary artery disease.
Purpose of the Study:
- To review the utility of CTA in evaluating acute chest pain.
- To compare CTA with existing diagnostic strategies.
- To propose an algorithm for integrating CTA into emergency department protocols.
Main Methods:
- Review of current literature on CTA for acute chest pain.
- Analysis of CTA's sensitivity and negative predictive value.
- Comparison of CTA outcomes with traditional methods.
Main Results:
- CTA demonstrates high sensitivity and negative predictive value for excluding obstructive coronary artery disease.
- CTA can quickly identify low-risk patients, minimizing downstream major adverse cardiac events.
- CTA offers advantages in cost-effectiveness and efficiency over traditional approaches.
Conclusions:
- CTA is a valuable tool for evaluating acute chest pain in the emergency department.
- Implementation of CTA can streamline patient care and improve resource utilization.
- Further research and standardized algorithms can optimize CTA's role in clinical practice.
Abstract:
Chest pain is a common complaint in the emergency department often necessitating testing to exclude underlying obstructive coronary artery disease. While the traditional evaluation of patients with suspected acute coronary syndrome often consists of serial electrocardiograms and cardiac biomarkers, followed by selective use of stress testing for further risk stratification, this approach is costly and inefficient. Recently, coronary computed tomographic angiography (CTA) has offered an alternative approach with a high sensitivity and negative predictive value to exclude obstructive coronary artery disease that can rapidly identify patients with low rates of downstream major adverse cardiac events. In this review, the authors provide an overview of available data on the use of CTA for evaluating acute chest pain, while emphasizing its advantages and disadvantages compared to existing strategies. In addition, we provide a suggested algorithm to identify how CTA can be incorporated into the evaluation of acute chest pain and discuss tips for successful implementation of CTA in the emergency department.
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