|In contrast to the situation of patients with ambulatory presentations with chest pain, acute presentations may require testing of individuals who, on clinical grounds, are at low risk of CAD.|
|The high predictive value of a negative coronary CTA scan, which does not require provocative testing (and therefore observation before testing), has engendered interest in the use of this test to exclude CAD, shorten hospital stay, and reduce the cost of evaluation.|
|In addition to planned definitive trials, a decision-analytic model could help define the most cost-effective approach, based on the observed accuracy and prognostic implications of testing across multiple studies.|
|The anticipated CTA-based strategy involves immediate performance of CTA, without a period of observation, in patients presenting with chest pain but no diagnostic changes on the electrocardiogram. Patients with a completely normal CTA would be discharged, and those with an ambiguous result would undergo additional observation and testing with stress SPECT.|
|In these models of a patient group at low risk of CAD and prevalence 2% to 30%, CTA with confirmatory SPECT was cost saving (lower costs, higher QALYs) compared with a CTA-only strategy, stress ECG, Echo, and SPECT. However, CTA may be associated with a higher event rate in negative patients than SPECT, and the diagnostic and prognostic information for the use of CTA in the emergency department is scarce and still emerging.|
Abbreviations as in Tables 1 to 3.