Role of Computed Tomography Cardiac Angiography in Acute Chest Pain Syndromes

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Use of computed tomography coronary angiography (CTCA) to evaluate chest pain has rapidly increased over recent years. Whilst its utility in the diagnosis of coronary artery disease in stable chest pain syndromes is clear and is strongly endorsed by international guidelines, the role of CTCA in the acute setting is less certain. In the low risk setting, CTCA has been shown to be accurate, safe and efficient but inherent low rates of adverse events in this population and the advent of high sensitivity troponin testing has left little room for CTCA to show any short term clinical benefit.

In higher risk populations CTCA has potential to fulfil a gatekeeper role to invasive angiography. The high negative predictive value of CTCA is maintained, whilst also identifying non obstructive coronary disease and alternative diagnoses in the substantial group of patients presenting with chest pain who do not have type one myocardial infarction. For those with obstructive coronary disease, CTCA provides accurate assessment of stenosis severity, characterisation of high risk plaque and findings associated with perivascular inflammation. This may allow more appropriate selection of patients to proceed to invasive management with no disadvantage in outcomes and can provide a more comprehensive risk stratification to guide both acute and long term management than routine invasive angiography.
Original languageEnglish
Publication statusPublished - 13 Mar 2023


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