Coronary angiotomography in the emergency department

Coronary computed tomography angiography (CCTA) has evolved to be a flexible and cost-effective technique to classify the potential risk of cardiopulmonary pathologies presenting as acute chest pain (ACP) in the emergency department (ER). Mainly, CCTA has become a safe strategy for the diagnosis and stratification in ACP patients with low to intermediate likelihood of having acute coronary syndrome (ACS) and coronary artery disease (CAD). In fact, CCTA shows several advantages tested in prospective clinical trials including reduction in the time to diagnose CAD, increase in patient discharge from the ER, lower cost and reduction in hospital stay compared with standard of care due to rapid acquisition and very high accuracy (negative predictive value: 85-99% and sensitivity: 85-99%). In this review, we will focus on the early use of CCTA in the ER as a fundamental tool for risk stratification, prognosis and safety for discharge in patients with symptoms suggestive of ACS. This article includes CCTA indications, protocols and CAD characterization of this imaging technique over the last twenty years and future directions.