R-SCAN: Cardiac CT Angiography for Acute Chest Pain.
J Am Coll Radiol. 2017 Sep;14(9):1212-1214. doi: 10.1016/j.jacr.2017.05.009. Epub 2017 Jul 20. Woodard PK1, McWilliams SR2, Raptis DA2, Hollander JE3, Litt HI4, Villines TC5, Truong QA6.
Acute chest pain is one of the most common reasons for emergency department visits in the United States, accounting for more than eight million emergency department encounters each year [1-3]. Acute chest pain—or anginal equivalents such as shortness of breath, diaphoresis, or nausea—must be taken seriously as potential indicators of acute coronary syndrome (ACS). Acute chest pain warrants immediate assessment of patient risk, including a 12-lead electrocardiogram (ECG) examination and an initial serum troponin evaluation . Although coronary CT angiography (CCTA) plays an indispensable role in triaging emergency department patients with low to intermediate risk for ACS, patients with ST segment elevation myocardial infarction should be admitted and considered for invasive coronary angiography and potential percutaneous coronary intervention. Patients with ECG or biomarker evidence of ischemia are best managed by an early invasive strategy involving invasive angiography. Risk here is defined by the Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina or ACS . The TIMI score is used to determine the likelihood of ischemic event or mortality in patients with unstable angina or non–ST-segment elevation myocardial infarction . Failure to provide the appropriate care to patients presenting with true ACS may result in long-term complications such as ischemic cardiomyopathy and heart failure at best and cardiac death at worst.