Coronary CT Angiography for Safe Discharge of patients with possible ACS

Patients who present with acute chest pain that is believed to be of ischemic origin but who have normal initial biochemical markers for myocardial necrosis and normal or nondiagnostic electrocardiograms (ECG) represent a major diagnostic challenge to emergency departments (ED).Multiple large clinical multicentre trials were done to evaluate role of coronary CT Angiography in emergency department.In ROMICAT-I they demonstrated that 50% of patients who presented with acute chest pain to the ED and were at low to intermediate likelihood of ACS had no CAD by coronary CTA, a finding that has 100% NPV but limited PPV for the subsequent diagnoses of ACS and MACE.In other large multicentre trial by Harold I. Litt and colleagues showed a CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible acute coronary syndrome appears to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted.In ROMICAT-II, in patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care.Conclusion: Coronary CT Angiography is appropriate modality for safe discharge and decreased the average length of Hospital stay for low-to-intermediate-risk patients who come to emergency department with chest pain.