title: Coronary computed tomographic angiography in the emergency room: state of the art.
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.
authors.affiliation: Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Non-Invasive Cardiovascular Imaging Program, Boston, MA, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Cheezum
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.forename: Edward A
authors.initials: EA
authors.lastname: Hulten
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000503:physiopathology; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital; D005080:Exercise Test / Q000379:methods; D006801:Humans; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D015415:Biomarkers