Coronary computed tomography angiography for the assessment of acute chest pain in the emergency department: evidence, guidelines, and tips for implementation

Journal of Thoracic Imaging
Alan RoppCharles S White

Abstract

Acute chest pain is an important clinical challenge and a major reason for presentation to the emergency department. Although multiple imaging techniques are available to assess such patients, considerable interest has focused on the use of coronary computed tomography (CT) angiography. Three recent multicenter trials have demonstrated the value of coronary CT angiography (CCTA) to diagnose patients with acute coronary syndrome (ACS) rapidly and accurately. Guidelines developed on the basis of these and other studies suggest that CCTA is optimally used in patients with low to intermediate risk for ACS. A related protocol, the triple rule-out scan, may be valuable if overlapping symptoms occur, particularly between those of ACS and pulmonary embolism. In developing a program to perform CCTA in the emergency room, it is important to work closely with emergency physicians and cardiologists to maximize appropriate use of this technique and to develop appropriate protocols that minimize radiation dose. Ongoing efforts to improve existing capabilities of CCTA include better characterization of coronary plaque and the use of CT fractional flow reserve and perfusion techniques.

References

Jun 16, 2006·Heart·Susanne KorffEvangelos Giannitsis
Feb 2, 2010·Journal of the American College of Cardiology·Morton J Kern, Habib Samady
Mar 30, 2013·Journal of Cardiovascular Computed Tomography·Ricardo C CuryAllen J Taylor

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Citations

Dec 20, 2015·Academic Radiology·Matthew E ZygmontJason N Itri
Apr 19, 2015·Journal of Thoracic Imaging·Sanjeev Bhalla, Ioannis Vlahos
May 18, 2016·AJR. American Journal of Roentgenology·Amelia M Wnorowski, Ethan J Halpern
Sep 17, 2015·Insights Into Imaging·Sebastiaan HammerAlbert de Roos
Dec 24, 2016·Current Opinion in Pulmonary Medicine·Lauran StögerBram H J Geurts

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Methods Mentioned

BETA
dissection

Software Mentioned

CT
ROMICAT
STAT

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