The Potential Role of Combined Highly Sensitive Troponin and Coronary Computed Tomography Angiography in the Evaluation of Patients with Suspected Acute Coronary Syndrome in the Emergency Department

The evaluation and triage of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) remains to be challenging despite available guidelines and clinical evidence. The current guidelines in the USA recommend clinical risk assessment based on cardiovascular risk factors followed by serial electrocardiograms and conventional cardiac troponin measurements, which are supplemented by advanced non-invasive cardiac testing in the majority of patients. This approach is safe, but leads to a lengthy work-up and high cost of care. There is clinical need for diagnostic strategies that will lead to rapid and reliable triage of patients with suspected ACS. In this review, we will summarize the experience and evidence for the use of highly sensitive troponin (hsTn) in the rapid and efficient evaluation of patients with suspected ACS. We will also review the available literature on the use of coronary computed tomography angiography (CTA) in the rapid evaluation of patients with suspected ACS. We will discuss the opportunities for the combined use of hsTn and coronary CTA in this population. Finally, we will outline the possible implementation of combined use of hsTn and coronary CTA in the evaluation of patients with suspected ACS in the ED.