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.

CT coronary angiography in the investigation of chest pain — Beyond coronary artery atherosclerosis; A pictorial review

“…CTCA protocol modification allows a simultaneous assessment of the coronary arteries, thoracic aorta and pulmonary arteries in a single study -'Triple Rule Out' protocol [13,89]. Although an attractive technique in the investigation of chest pain, the increased diagnostic yield in unselected patients does not support the generalised use of this technique [88,90].…”

A New Approach To Chest Pain in the Emergency Room: “Triple Rule-Out CT

“…Böbrek yetmezliği kontrast madde kullanımını sınırlayan diğer bir faktör olarak karşı-mıza çıkmaktadır. Glomerüler filtrasyon hızı 45ml/dk'nın altında olan hastalara yapılması önerilmemektedir (12).…”

Coronary Angiographic Evaluation of Low-Risk Chest Pain in the Emergency Department

“…of these prior studies demonstrate a pooled sensitivity of 92%, specificity of 89%, and a very high negative predictive value (NPV) of 99% (2). The positive predictive values for detecting significant coronary artery disease (CAD) have been moderate, ranging from 33% to 95% with a pooled estimate of 48%.…”