Background:
Acute chest pain is one of the most common reasons for Emergency Department
(ED) visits and hospital admissions. As this could represent the first symptom of a lifethreatening
condition, urgent identification of the etiology of chest pain is of utmost importance in
emergency settings. Such high-risk conditions that can present with acute chest pain in the ED include
Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and Acute Aortic Syndromes
(AAS).
Discussion:
The concept of Triple Rule-out Computed Tomographic Angiography (TRO-CTA) for
patients presenting with acute chest pain in the ED is based on the use of coronary computed tomographic
angiography as a single imaging technique, able to diagnose or exclude three lifethreatening
conditions in one single step: ACS, AAS and PE. TRO-CTA protocols have been
proved to be efficient in the ED for diagnosis or exclusion of life-threatening conditions and for
differentiation between various etiologies of chest pain, and application of the TRO-CTA protocol
in the ED for acute chest pain of uncertain etiology has been shown to improve the further clinical
evaluation and outcomes of these patients.
Conclusion:
This review aims to summarize the main indications and techniques used in TRO protocols
in EDs, and the role of TRO-CTA protocols in risk stratification of patients with acute chest
pain.