Newer imaging methods for triaging patients presenting to the emergency department with chest pain

Three small single-center studies using EBCT in the ED to risk stratify patients who have chest pain and nondiagnostic ECGs show promising results, but limitations of this approach are apparent. Although patients who did not have coronary calcium detected by EBCT had very low adverse event rates, EBCT in this setting can be associated with poor positive predictive value that would lead to at least the need for another cardiac test, such as stress testing, or even unnecessary hospital admission. Before EBCT is adopted as routine practice in this patient population, a large multicenter study of consecutive patients is required to better ascertain for which subset of patients this would be an effective strategy. This subset would likely include a younger population that does not have a history of CAD. Ideally this would lead to a randomized diagnostic trial comparing EBCT in this population with some form of stress testing. Other imaging technologies, including cardiac MRI and MSCT, are even less well studied in this patient population, but may prove to be of value in this setting in the future. Limited data with 64 slice scanners indicate diagnostic quality coronary imaging in many patients and a high degree of reliability of a negative study. However, although the technique has important potential, significant limitations remain and there are currently no reported studies of its utility in the ED setting.