The ACUTE CT trial is designed to test whether the assessment of chest structures by high-resolution multislice computed tomography (CT) provides equivalent diagnostic accuracy for patient with acute chest pain or other potential cardiac symptoms as compared to a standard of care evaluation.

Adults at low to intermediate risk of acute coronary syndrome who present to the Emergency Department with symptoms suggestive of cardiac ischemia will undergo a blinded cardiac CT followed by a standard of care (SOC) strategy. Significant coronary artery disease on CT (coronary stenosis >50%) will be compared to an adjudicated diagnosis derived from clinical data and other diagnostic tests based on the SOC strategy. Costs for the SOC evaluation will be collected and compared to a CT-based evaluation. Patients will be followed for 3 years after enrollment to evaluate prognosis.

Inclusion Criteria:

• Low to intermediate risk of angina with a TIMI ACS Risk Score ≤ 4
• chest pain or other symptoms suggestive of ACS within 24 hours
• male ≥30 years or female ≥45 years old
• at least one cardiac risk factor
• no obvious cause for symptoms.

Exclusion Criteria:

• known CAD
• ST segment elevation, new left bundle branch block or dynamic ECG changes
• creatinine ≥1.8 g/dL
• pregnant or lactating female
• hemodynamic or respiratory instability
• ongoing bronchospasm
• known iodinated contrast allergy
• atrial fibrillation or irregular heart rate

Alll patients presenting to the University of Washington Medical Center Emergency Department with possible acute coronary syndrome