Cardiac CT in the Emergency Department

Acute chest pain is one of the most common chief complaints in patients presenting to the emergency department (ED) in the United States, accounting for approximately seven million visits every year [1]. Accurate early triage of these patients remains a major diagnostic challenge, as an acute coronary syndrome (ACS) is ultimately diagnosed in only 2-8% of these patients [2]. Clinical presentation, chest pain history, and clinical risk factors are important in the evaluation of patients, but they do not allow for a definitive exclusion of ACS [3], so the standard of care for patients with acute chest pain includes serial electrocardiograms and troponin measurements, often in chest pain observation units, followed by more advanced diagnostic testing with or without imaging (Fig. 10.1) [4-9]. Despite this conservative practice, which is associated with high costs, about 2% of patients with ACS are inappropriately discharged [10]. Therefore, diagnostic strategies that lead to rapid and reliable early triage of patients with acute chest pain are desirable.