Acute chest pain imaging in the emergency department with cardiac computed tomography angiography

In practice, the determination of ischemic chest pain in the emergency department (ED) population is difficult and errors are common. Cardiac computed tomography angiography has recently emerged for accurate noninvasive evaluation of coronary artery disease, and it may offer a promising new approach to improve the triage of patients presenting to the ED with acute chest pain, in particular in terms of a faster and accurate way to determine the diagnosis, which could effectively reduce hospital admissions and costs. The focus of this article is to review the current literature on the use of cardiac computed tomography angiography in the ED setting by providing pooled sensitivity, specificity, and positive and negative predictive values of the published literature to date. Moreover, different protocols for detection of patients with cardiac and other, noncardiac causes of chest pain (triple rule-out protocol) are discussed.