Newer imaging methods for triaging patients presenting to the emergency department with chest pain

The usefulness of electron beam CT (EBCT) for the risk stratification of patients in the emergency department (ED) who have possible acute coronary syndrome has been evaluated in three small studies. The results of these studies are promising, as patients who have no coronary calcium detected by EBCT essentially had no adverse cardiac events. Although the negative predictive value of EBCT was excellent, the limited positive predictive value that would lead to further diagnostic testing makes this strategy less attractivei f applied to a broad population. Further larger studies may help define which patients in the ED who have chest pain and nondiagnostic ECGs can be effectively evaluated by EBCT. Recent advances in noninvasive coronary angiography by multislice computed tomography are of considerable interest in the ED evaluation of patients with undefined chest pain, but the utility of this method in this setting awaits clinical studies.