Coronary computed tomographic angiography (CCTA) in community hospitals: “current and emerging role”

Rakesh K Sharma¹, Donald J Voelker¹, Rajiv K Sharma¹, Vibhuti N Singh², Girish Bhatt¹, Mathilde Moazazi¹, Teresa Nash¹, Hanumanth K Reddy¹

¹Medical Center of South Arkansas, El Dorado, University of Arkansas for Medical Sciences, Little Rock, AR, USA; ²Bayfront Medical Center, St Petersburg, University of South Florida, FL, USA

Abstract: Coronary computed tomographic angiography (CCTA) is a rapidly evolving test for diagnosis of  coronary artery disease. Although invasive coronary angiography is the gold standard for coronary artery disease (CAD), CCTA is an excellent noninvasive tool for evaluation of chest pain. There is ample evidence to support the cost-effective use of CCTA in the early triage process of patients presenting with chest pain in the emergency room. CCTA plays a critical role in the diagnosis of chest pain etiology as one of potentially fatal conditions, aortic dissection, pulmonary embolism, and myocardial infarction. This ‘triple rule out’ protocol is becoming an increasingly practicable and popular diagnostic tool in ERs across the country. In addition to a quick triage of chest pain patients, it may improve quality of care, decrease cost, and prevent medico-legal risk for missing potentially lethal conditions presenting as chest pain. CCTA is also helpful in the detection of subclinical and vulnerable coronary plaques. The major limitations for wide spread acceptance of this test include radiation exposure, motion artifacts, and its suboptimal imaging with increased body mass index.

Keywords: calcium scoring, computed tomography, coronary artery disease (CAD), angiography, coronary CTA, chest pain, community hospitals, emergency room, pulmonary embolism, aortic dissection