Coronary CT Angiography for Acute Chest Pain in the Emergency Department: A Systematic Review of Clinical Utility
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Le résumé fourni par la source
Introduction: Chest pain is one of the most common and high-risk presentations in the emergency department (ED), necessitating timely and accurate evaluation to prevent adverse cardiovascular outcomes. Coronary Computed Tomography Angiography (CCTA) has emerged as a promising non-invasive modality with high sensitivity (90–100%) and a negative predictive value (98–100%) for ruling out significant coronary artery disease (CAD), as evidenced by trials such as ROMICAT II and ACRIN-PA. Despite its expanding role in ED triage, further evaluation of its impact on patient-centered outcomes is essential. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between January 2010 and June 2025 were identified from PubMed, Embase, and the Cochrane Library. Eligible studies included randomized controlled trials and prospective cohort studies assessing CCTA in ED patients with suspected acute coronary syndrome (ACS), compared with alternative diagnostic strategies, and reporting outcomes, including diagnostic accuracy, time to diagnosis, ED discharge rates, hospital admissions, and cost-effectiveness. Results: Twenty-three studies comprising over 60,000 patients were included. CCTA in low- to intermediate-risk patients significantly reduced diagnostic time (up to 54%), increased early ED discharges, and lowered unnecessary admissions. It consistently demonstrated excellent diagnostic performance, with pooled sensitivity ≥90% and near-perfect negative predictive value. Economic evaluations showed reduced costs due to shorter ED stays and less downstream testing. Challenges included radiation exposure, contrast use, and incidental findings. Conclusions: CCTA enhances ED efficiency and safety in ACS evaluation, offering accurate CAD exclusion and resource optimization. Future studies should explore its long-term cost-effectiveness and integration into high-sensitivity troponin protocols.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Coronary CT Angiography for Acute Chest Pain in the Emergency Department: A Systematic Review of Clinical Utility
- Date Crossref
- 22/09/2025
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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UCLA Medical Center pays non établi dans la noticeÉtablissement de santé
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University of West Los Angeles pays non établi dans la noticeUniversité ou école supérieure
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University of California Department of Radiology pays non établi dans la noticeUniversité ou école supérieure
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West Los Angeles College pays non établi dans la noticeUniversité ou école supérieure
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Department of Veterans Affairs pays non établi dans la noticeOrganisme public
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VA Greater Los Angeles Healthcare System pays non établi dans la noticeÉtablissement de santé
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The Lundquist Institute for Biomedical Innovation pays non établi dans la noticeStructure de recherche
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Division of Cardiology pays non établi dans la noticeInstitution
UCLA Medical Center, University of West Los Angeles et Department of Radiology — University of California, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.