The Society of Cardiovascular Computed Tomography (SCCT) has just released a consensus document on the use of coronary computed tomographic angiography (CTA) to evaluate chest pain in the emergency room. In the US, over 9 million patients present to the emergency department with acute chest pain on an annual basis. Appropriate and accurate evaluation of acute chest pain is imperative to improve efficiency and save costs. It also can help to ensure that acute coronary syndrome (ACS) is not missed.
Advantages of Coronary CTA
Coronary CTA can confirm or rule out the presence of obstructive coronary artery disease with a high degree of accuracy. It can also be used to evaluate plaque burden, lessen time-to-diagnosis, shorten hospital stays and is associated with a low rate of complications. Furthermore, it can be used in conjunction with high sensitivity troponin (hs-cTn) assays to identify the presence of ACS. Finally, coronary CTA is associated with reduced costs and resource utilization.
The consensus document summarizes evidence from clinical trials which have evaluated the clinical utility of, and outcomes associated with coronary CTA. It also reviews site requirements for implementation of such evaluation (equipment, staff, training, etc.). Interpretation and reporting requirements are provided. Protocols for appropriate patient selection are included, along with different clinical scenarios to demonstrate recommended diagnostic pathways for patients with and without known coronary artery disease (CAD).
The need for patient-centric shared decision-making is emphasized. Prior to undergoing CT evaluation, patients must be properly screened and educated, and provide informed consent. A heart rate-lowering medication such as metoprolol or ivabradine may be needed.
Challenges and Contraindications
The authors review scenarios in which coronary CTA may be challenging and provide helpful suggestions to address these challenges. In addition, an overview of situations in which CT evaluation may be contraindicated are provided, along with strategies to improve safety.
Coronary CTA Endorsements
The American College of Cardiology, the American Heart Association, and the European Society of Cardiology have all endorsed the use of coronary CTA for the evaluation of acute chest pain in the emergency department.
Author: Kelly Schoonderwoerd
Original Article: Maroules CD et al. J Cardiovasc Comput Tomogr. 2022.