Cardiac CT in the assessment of acute chest pain in the emergency department.
OBJECTIVE
The purpose of this article is to describe the current role of ECG-synchronized 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.


CONCLUSIONS
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.
Bastarrika
Gorka
G
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr., Charleston, SC 29425, USA.
Thilo
Christian
C
Headden
Gary F
GF
Zwerner
Peter L
PL
Costello
Philip
P
Schoepf
U Joseph
UJ
D000328:Adult; D000792:Angiography / Q000379:methods; D002637:Chest Pain / Q000000981:diagnostic imaging*; D003327:Coronary Disease / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000191:economics / Q000379:methods*; D004632:Emergency Medical Services / Q000191:economics / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis; D019057:Quality-Adjusted Life Years; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*