title: Cardiac CT in the emergency department: convincing evidence, but cautious implementation.
abstract: In clinical practice, assessment of chest pain patients presenting to the emergency department is difficult and the work-up can be lengthy and costly. There is growing evidence supporting the use of coronary computed tomography angiography (CTA) in early assessment of patients presenting with acute chest pain to the emergency department. CTA appears to be a faster and more accurate way to diagnosis or rule out coronary stenosis, leading to reduced hospital admissions, decreased time in the ED and lower costs. The focus of this article is to review the current literature of the use of Coronary CTA and "triple rule out" protocols in the emergency department setting and to provide a chest pain algorithm, showing how Coronary CTA can be implemented effectively in clinical practice. Potential pitfalls and requirements for implementation will also be discussed.
authors.affiliation: Baptist Hospital of Miami and Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL, USA. rcury@baptisthealth.net
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Carol
authors.initials: C
authors.lastname: Mascioli
authors.forename: Jonathon
authors.initials: J
authors.lastname: Fialkow
authors.forename: Paul
authors.initials: P
authors.lastname: Andrulonis
authors.forename: Tomas
authors.initials: T
authors.lastname: Villanueva
authors.forename: Constantino S
authors.initials: CS
authors.lastname: Pena
authors.forename: Warren R
authors.initials: WR
authors.lastname: Janowitz
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
authors.forename: Jack A
authors.initials: JA
authors.lastname: Ziffer
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006801:Humans; D014057:Tomography, X-Ray Computed / Q000379:methods*