title: Coronary CT angiography versus standard of care for assessment of chest pain in the emergency department.
abstract: Use of coronary CT angiography (CTA) in the early evaluation of low-intermediate risk chest pain in the emergency department represents a common, appropriate application of CTA in the community. Three large randomized trials (CT-STAT, ACRIN-PA, and ROMICAT II) have compared a coronary CTA strategy with current standard of care evaluations in >3000 patients. These trials consistently show the safety of a negative coronary CT angiogram to identify patients for discharge from the emergency department with low rates of major adverse cardiovascular events, at significantly lower cost, and greater efficiency in terms of time to discharge. Together, these trials provide definitive evidence for the use of coronary CTA in the emergency department in patients with a low-to-intermediate pretest probability of coronary artery disease. Clinical practice guidelines that recommend the use of coronary CTA in the emergency department are warranted.
authors.affiliation: Baptist Health of South Florida and Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA. rcury@baptisthealth.net
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Taylor
mesh_terms: D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality*; D015897:Comorbidity; D017023:Coronary Angiography / Q000592:standards / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D006801:Humans; D007902:Length of Stay; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D059039:Standard of Care; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States