Coronary computed tomography angiography for the evaluation of patients with acute chest pain

• Published in: International journal of clinical practice (Esher) Vol. 65; no. 12; pp. 1267 - 1273
• Main Authors: Rajani, R., Brum, R. L., Preston, R., Carr-White, G., Berman, D. S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2011; Wiley-Blackwell; Hindawi Limited
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Acute Pain; Adult; Biological and medical sciences; Cardiovascular system; Chest Pain - diagnostic imaging; Chest Pain - economics; Chest Pain - etiology; Coronary Angiography - adverse effects; Coronary Angiography - economics; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - economics; Coronary vessels; Cost-Benefit Analysis; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Female; Forecasting; General aspects; Humans; Incidental Findings; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pain management; Patients; Prognosis; Radiation Dosage; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Tomography; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - methods; Human; Evaluation; Angiography; Radiodiagnosis; Acute; Patient; Thorax; Coronary arteriography; Medicine; Pain; Medical imagery; Computerized axial tomography; Angiocomputed tomography
• ISSN: 1368-5031; 1742-1241
• DOI: 10.1111/j.1742-1241.2011.02788.x

Summary Acute chest pain is a common presenting complaint of patients attending emergency room departments. Despite this, it can often be challenging to completely exclude a diagnosis of acute coronary syndrome following an initial standard clinical and biochemical evaluation. As a result of this, patients are often admitted to hospital until the treating clinician is satisfied that this diagnosis can be excluded. This process imparts a significant health economic burden by not only increasing hospital bed occupancy rates but also by the unnecessary layering of diagnostic investigations. With the rapid advances in coronary computed tomography angiography (CTA), there has been considerable interest in whether coronary CTA may be a viable alternative to this current standard care. We review the current literature and supporting evidence for utilising coronary CTA in the evaluation of patients presenting with acute chest pain in terms of its diagnostic accuracy, safety, cost‐effectiveness and prognostic implications.