CT Angiography Versus Routine Stress Testing for Patients with Chest Pain Seen in the Emergency Room to Exclude Significant Coronary Artery Disease

RODRIGUEZ GRANILLO GA; CARRASCOSA P

Controversies in Cardiology

Springer

Año: 2015; p. 83 - 98

Thetriage of low-to-intermediate risk patients presenting at the emergencydepartment (ED) with acute chest pain based on symptoms, initial 12-lead ECG,and a single set of biomarkers of myocardial necrosis usually fails to providea fast and safe discharge without further diagnostic testing. Among low riskpatients with normal or non-diagnostic ECG and negative initial cardiacenzymes, stress imaging (particularly stress-only SPECT) is an effectivestrategy to safely discharge patients; with a very high negative predictivevalue to predict myocardial infarction or future adverse cardiac events.Computed tomography coronary angiography (CTCA) has emerged a fast, safe, andpossibly cost effective means to exclude coronary artery disease (CAD) as thecause of an acute coronary syndrome in the ED in patients atlow-to-intermediate risk of CAD; and provides a long-term event-free safetywindow with zero events after a mean 52-month follow-up. CTCA is associatedwith a mild (2 %) but significant difference in the rates of invasiveangiography and coronary revascularization, but with a higher diagnostic yield.Further studies are warranted to define whether CTCA plus confirmatory stressimaging for indeterminate results might be the most cost effective strategy.