Better Evaluation of Acute Chest Pain With Computed Tomography Angiography

Better Evaluation of Acute Chest Pain With Computed Tomography Angiography - A Randomized Controlled Trial

The purpose of this study is to determine whether cardiac CT can improve triage of acute chest pain patients in the emergency department.

Myocardial infarction remains one of the most important causes of death and disability. Therefore it is important that individuals with acute chest pain are accurately assessed without delaying appropriate treatment. Acute coronary syndrome is only one cause for sudden chest pain, which is a very common complaint in the ER. Other life threatening causes such as pulmonary embolism and aortic dissection may also be the cause, although most chest discomfort has a benign reason (musculoskeletal, hyperventilation, oesophageal reflux, etc).

The current work-up of suspected acute coronary syndrome, based on presentation, symptoms, ECG and biomarkers, is not efficient and results in unnecessary diagnostics and hospital admissions, as well as errors or delayed diagnoses, in a substantial number of patients. Computed tomography angiography (CTA) images atherosclerosis, coronary obstruction as well as myocardial hypoperfusion. We hypothesize that early use of CTA is of incremental value and allows for accurate and immediate triage of patients with acute chest pain.

Inclusion Criteria:

• Acute chest pain or equivalent
• Patients older than 30 years
• Males < 75 years and Females < 80 years

Exclusion Criteria:

• STEMI
• Troponin > 0.1
• History of known myocardial infarction, PCI or CABG
• Pregnancy
• Contrast allergy
• Renal disfunction
• No informed consent possible
• No follow-up possible