Chest pain is one of the most common reasons for presentation to the emergency room (ER).1-2 Perhaps one third of patients with chest pain will eventually be diagnosed with acute coronary syndromes. Many chest-pain patients have equivocal clinical findings, however, including normal cardiac enzyme levels and a nondiagnostic electrocardiogram (ECG). The potentially fatal consequences of inadvertently discharging a patient with acute myocardial infarction (MI) leads to approximately 2.8 million unnecessary inpatient hospital admissions each year in the United States, at an annual cost of >$6 billion.
Multislice computed tomography (CT) has the potential to more effectively triage patients who present to the ER with chest pain. Through the use of coronary calcium scoring, coronary CT angiography (CTA), and triple rule-out studies, CT can quickly determine whether a patient has significant coronary artery stenosis, aortic dissection, or pulmonary embolism. The potential for more accurate and efficient triage must be balanced against the limitations of performing CT in the ER setting, however. These include increased radiation exposure, the need for heart rate control, and difficulties in contrast administration.