Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department
OBJECTIVE. The purpose of this article is to describe the current role of ECG-synchronized CT in the evaluation of patients with acute chest pain (triple rule-out) in the emergency department. We discuss clinical contexts of the chest pain algorithm, technical improvements that have enabled CT to attain its current role for this application, scan protocols and radiation considerations, the evidence base regarding diagnostic and prognostic performance, and initial data on the cost-effectiveness of this promising emerging test.
CONCLUSION. Currently available evidence suggests that CT-based approaches with modern scan technology are safe, accurate, and potentially cost-saving, although large-scale clinical trials are needed to ascertain the precise role of CT in the evaluation of acute chest pain.
Acute chest pain in the emergency department (ED) is one of the most daunting health care challenges. In 2006, there were 119.2 million visits to hospital EDs in the United States [1]. According to the latest National Hospital Ambulatory Medical Care Survey, the most common specific reasons given by adult patients (15 years and older) for visiting the ED were, in descending frequency, chest pain, abdominal pain, back pain, headache, and shortness of breath, with an estimated 6.4 million patient visits for chest pain [1]. In the United States alone the estimated cost of evaluating patients with acute chest pain in the ED exceeds $10 billion annually [2]. Although most patients with acute chest pain do not have a life-threatening underlying condition, a large proportion of these patients are unnecessarily admitted for observation, which puts additional strain on already limited resources [3, 4]. The most clinically relevant conditions causing chest pain that have to be differentiated in the ED are pulmonary embolism, acute aortic syndrome, and coronary artery disease presenting as acute coronary syndrome. The last condition is identified in approximately 15–25% of patients with acute chest pain who are evaluated in EDs [5]. Unfortunately, the number of patients with manifestations of acute myocardial infarction who are inappropriately discharged from the ED is not negligible [6–8]. (…)
Full article: AJR Am J Roentgenol. 2009 Aug;193(2):397-409.
References
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Authors: Gorka Bastarrika, Christian Thilo, Gary F. Headden, Peter L. Zwerner, Philip Costello, U. Joseph Schoepf
