Cardiac computed tomography in patients with acute chest pain

Eur Heart J. 2015 Apr 14;36(15):906-14. doi: 10.1093/eurheartj/ehv034. Epub 2015 Feb 16.


The efficient and reliable evaluation of patients with acute chest pain is one of the most challenging tasks in the emergency department. Coronary computed tomography (CT) angiography may play a major role, since it permits ruling out coronary artery disease with high accuracy if performed with expertise in properly selected and prepared patients. Several randomized trials have established early cardiac CT as a viable safe and potentially more efficient alternative to functional testing in the evaluation of acute chest pain. Ongoing investigations explore whether advanced anatomic and functional assessments such as high-risk coronary plaque, resting myocardial perfusion, and left ventricular function, or the simulation of the fractional coronary flow reserve will add information to the anatomic assessment for stenosis, which would allow expanding the benefits of cardiac CT from triage to treatment decisions. Especially, the combination of high-sensitive troponins and coronary computed tomography angiography may play a valuable role in future strategies for the management of patients presenting with acute chest pain.

Keywords: Acute chest pain; Acute coronary syndrome; Computed tomography; Diagnostic triage; Myocardial infarction; Review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Pain / diagnostic imaging
  • Chest Pain / diagnostic imaging*
  • Chest Pain / etiology
  • Coronary Angiography / methods
  • Diagnosis, Differential
  • Emergencies
  • Emergency Service, Hospital
  • Forecasting
  • Humans
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Revascularization / methods
  • Observational Studies as Topic
  • Plaque, Atherosclerotic / diagnostic imaging
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Tomography, X-Ray Computed / methods
  • Triage / methods
  • Troponin / metabolism


  • Troponin