Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

P atients with acute chest pain (ACP) represent a globalhealth and economical challenge for the US healthcare system.The more than 8 million annual emergency department (ED) visits impart a significant economic burden in excess of $8 billion annually, [1][2][3] particularly as 80% of these patients are admitted to the hospital and subsequently undergo extensive testing for what often turns out to be noncardiac chest pain.However, 2% to 8% of discharged patients inadvertently have acute coronary syndrome (ACS), 4 -7 which accounted for 26% of all money paid in closed malpractice claims in emergency medicine from 1985 to 2003.8,9 Response by Hendel on p 263Based on the current classification, diagnosis, and management of patients with ACP, this article reviews the role of currently available functional diagnostic tests and potential of cardiac CT to improve management of these patients by direct and noninvasive assessment of coronary artery disease (CAD).To provide a rationale for the use of cardiac CT, we provide a summary of available data on the accuracy of cardiac CT for the detection of coronary atherosclerotic plaque and stenosis, as well as the assessment of left ventricular function.Based on a discussion of the health and economic risk benefit aspects of this new technology, we suggest how cardiac CT could be implemented into the current guidelines to improve accuracy and efficacy of current treatment of patients with acute chest pain. Classification of Acute Coronary SyndromeAcute coronary syndrome is an operational term and describes a clinical syndrome that comprises both the diagnosis of acute myocardial infarction (AMI) and unstable angina pectoris.10 Although myocardial necrosis caused by ischemia is the histological substrate of AMI, unstable angina pectoris (UAP) is characterized by ischemia without sufficient myo-The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.