What is the role of CT coronary artery scoring in the workup of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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CT coronary artery scoring is emerging as an attractive risk stratification tool in patients who are low risk for ACS. This imaging modality exposes the patient to very little radiation (1-2 msV). No contrast is needed, and the study does not have a requirement for heart rate. [47]

The CAPTURE study, a randomized diagnostic trial, compared the efficacy a comprehensive cardiothoracic CT examination in the evaluation of patients presenting to the emergency department with undifferentiated acute chest discomfort or dyspnea. [48] Comprehensive cardiothoracic CT scanning was reasonable, with a similar diagnostic yield to dedicated protocols, but it did not reduce the length of stay, rate of subsequent testing, or costs. The “triple rule out” protocol might be helpful in the evaluation of select patients, but these findings suggest that it should not be routinely used with the expectation that it will improve efficiency or reduce resource use.

Another study of the usefulness of CT for reducing hospital admission rates found that coronary computed tomographic angiography (CCTA) appears to allow safe, expedited discharge from the ED of low-to-intermediate-risk patients who would otherwise be admitted. [49]

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