Coronary Artery Calcium Scoring in the Emergency Department: Identifying Which Patients With Chest Pain Can Be Safely Discharged Home

Does Quantifying Epicardial and Intrathoracic Fat With Noncontrast Computed Tomography Improve Risk Stratification Beyond Calcium Scoring Alone?

“…[16][17][18] CACS can also risk stratify low to intermediate-risk patients with acute chest pain (ACP) of unclear cardiac pathogenesis who present to the emergency department for evaluation. 15 There are preliminary data that fat volumes may independently predict or further refine risk in asymptomatic patients when CACS is known. 19 Whether fat values can also improve risk stratification and thereby guide decision-making beyond the CACS in patients with ACP is unknown.…”

“…11 CACS severity is known to predict risk for cardiac events in asymptomatic [12][13][14] and symptomatic 14,15 individuals and beyond that provided by the Framingham risk score (FRS) or C-reactive protein. [16][17][18] CACS can also risk stratify low to intermediate-risk patients with acute chest pain (ACP) of unclear cardiac pathogenesis who present to the emergency department for evaluation.…”

“…The original study cohort has been previously described in detail. 15 Patients were excluded if they had prior CAD, ischemic ECG findings diagnostic of an acute coronary syndrome, an elevated initial troponin level, or hemodynamic instability. All patients underwent noncontrast CT after admission.…”

Optimizing Evaluation of Patients with Low-to-Intermediate-Risk Acute Chest Pain: A Randomized Study Comparing Stress Myocardial Perfusion Tomography Incorporating Stress-Only Imaging Versus Cardiac CT

“…CACS may also challenge SPECT, which requires additional patient preparation, must be performed in conjunction with a stressor modality through coordination of medical and technical staff, is dependent on radiotracer availability, has higher radiation exposure, and may require considerable expertise for accurate interpretation. Most low-to-intermediaterisk patients (;55%) with ACP have a CACS of 0 (7,17,(23)(24)(25)(26)(27)(28) in whom there is a low likelihood of abnormal SPECT (0.8%) (7) or significant CAD as shown in the current study. Pooled data from 8 studies and ours suggest high sensitivity (96%; 95% confidence interval, 92%-98%) and negative predictive accuracy (99.4%; 95% confidence interval, 99%-100%) (7,17,(23)(24)(25)(26)(27)(28) for excluding ACS with CACS, which is comparable to CTA or SPECT (3)(4)(5)(6)(7)9).…”

“…Whether CTA reduces radiation exposure or hospital costs is controversial (6). The role of unenhanced CT-derived coronary artery calcium score (CACS) in patient management is also unclear (7,8).…”