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DOI:10.2214/AJR.08.2265
AJR 2009; 193:397-409
© American Roentgen Ray Society

Review

Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department

Gorka Bastarrika1, Christian Thilo1,2, Gary F. Headden3, Peter L. Zwerner2, Philip Costello1 and U. Joseph Schoepf1,2

1 Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr., Charleston, SC 29425.
2 Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
3 Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.

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.

Keywords: acute chest pain • acute coronary syndrome • coronary artery disease • CT • triple rule-out


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