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Computed Tomographic Angiography for Risk Stratification in Patients with Acute Chest Pain – the Triple Rule-Out Concept in the Emergency Department

Author(s):

Marton-Popovici Monica*, Bela Merkely, Balint Szilveszter , Zsofia D. Drobni and Pal Maurovich-Horvath   Pages 1 - 12 ( 12 )

Abstract:


Background: Acute chest pain is one of the most common reasons for Emergency Department (ED) visits and hospital admissions. As this could represent the first symptom of a lifethreatening condition, urgent identification of the etiology of chest pain is of utmost importance in emergency settings. Such high-risk conditions that can present with acute chest pain in the ED include Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and Acute Aortic Syndromes (AAS).

Discussion: The concept of Triple Rule Out Computed Tomographic Angiography (TRO-CTA) for patients presenting with acute chest pain in the ED is based on the use of coronary computed tomographic angiography as a single imaging technique, able to diagnose or exclude three lifethreatening conditions in one single step: ACS, AAS and PE. TRO-CTA protocols have been proved to be efficient in the ED for diagnosis or exclusion of life-threatening conditions and for differentiation between various etiologies of chest pain, and application of the TRO-CTA protocol in the ED for acute chest pain of uncertain etiology has been shown to improve the further clinical evaluation and outcomes of these patients.

Conclusion: This review aims to summarize the main indications and techniques used in TRO protocols in EDs, and the role of TRO-CTA protocols in risk stratification of patients with acute chest pain.

Keywords:

Acute coronary syndromes, chest pain, aortic dissection, pulmonary embolism, triple rule-out, cardiac computed tomography.

Affiliation:

Department of Internal Medicine and Critical Care, Swedish Medical Center, Edmonds, Washington, MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Heart and Vascular Center, Semmelweis University, Budapest, Cardiovascular Imaging Research Group, MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest



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