Society of Cardiovascular Computed Tomography

View all recommendations from this society

Released February 21, 2013; Updated December 1, 2021

Don’t use coronary computed tomography angiography in high risk* emergency department patients presenting with acute chest pain.

To date, randomized controlled trials evaluating use of coronary computed tomography angiography for individuals presenting with acute chest pain in the emergency department have been limited to low or low-intermediate risk individuals. It is important, however, to use computed tomography to exclude causes such as aortic dissection or P.E with pulmonary embolism and thus advice ECG gated CTA in men >45 years and women >55 years and analyze and report the coronary arteries.

(* Risk defined by the Thrombolysis In Myocardial Infarction (TIMI) risk score for unstable angina/acute coronary syndromes.)

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Society of Cardiovascular Computed Tomography (SCCT) formed a committee panel made up of expert members of its existing Guidelines Committee and Publications and Statements Committee that would be dedicated to recommending between five and 10 questions that should be considered when ordering Coronary CT angiography and coronary artery calcium scoring. The panel reviewed and referred to SCCT’s existing and published guidelines, appropriate use criteria and support statements. Once questions were chosen, the list was referred to the SCCT Board of Directors, which then reviewed the draft list, offered feedback and narrowed the questions down to the five most important consideration points through online voting. The draft was returned to the working group panel, which fleshed out the chosen recommendations and cited its supporting evidence from currently published literature. The SCCT’s Board of Directors and Executive Board each then reviewed the final five items and implemented another round of edits before voting for final review and approval.

SCCT’s bylaws and its disclosure and conflict of interest policy can be found at www.scct.org.

Sources

Goldstein JA, Chinnaiyan KM, Abidov A, Achenbach S, Berman DS, Hayes SW, Hoffmann U, Lesser JR, Mikati IA, O’Neil BJ, Shaw LJ, Shen MYH, Valeti US, Raff GL. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Amer Coll Cardio [Internet]. 2011 Sep 27 [cited 2012 Nov 28];58(14):1414–22. Available from: www.ncbi.nlm.nih.gov/pubmed/21939822.

Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, Pope JH, Hauser TH, White CS, Weiner SG, Kalanjian S, Mullins ME, Mikati I, Peacock WF, Zakroysky P, Hayden D, Goehler A, Lee H, Gazelle GS, Wiviott SD, Fleg JL, Udelson JE. Coronary CT angiography versus standard evaluation in acute chest pain. N Eng J Med [Internet]. [cited 2012 Dec 7]. Available from: www.nejm.org/doi/full/10.1056/NEJMoa1201161.

Litt HI, Gatsonis C, Snyder B, Singh H, Miller CD, Entrikin DW, Leaming JM, Gavin LJ, Pacella CB, Hollander JE. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Eng J Med [Internet]. 2012 Apr 12;366(15):1393–403. Available from: www.ncbi.nlm.nih.gov/pubmed/22449295.

Frank L J Visseren, François Mach, Yvo M Smulders, David Carballo, Konstantinos C Koskinas, Maria Bäck, Athanase Benetos, Alessandro Biffi, José-Manuel Boavida, Davide Capodanno,
Bernard Cosyns, Carolyn Crawford, Constantinos H Davos, Ileana Desormais, Emanuele Di Angelantonio, Oscar H Franco, Sigrun Halvorsen, F D Richard Hobbs, Monika Hollander, Ewa A Jankowska, Matthias Michal, Simona Sacco, Naveed Sattar, Lale Tokgozoglu, Serena Tonstad, Konstantinos P Tsioufis, Ineke van Dis, Isabelle C van Gelder, Christoph Wanner, Bryan Williams, ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal, Volume 42, Issue 34, 7 September 2021, Pages 3227 -3337. Available from: https://doi.org/10.1093/eurheartj/ehab484

Jagat Narula , Y Chandrashekhar , Amir Ahmadi , Suhny Abbara , Daniel S Berman , Ron Blankstein , Jonathon Leipsic , David Newby , Edward D Nicol , Koen Nieman , Leslee Shaw , Todd C
Villines , Michelle Williams , Harvey S Hecht . SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed
Tomography. J Cardiovasc Comput Tomogr. May-Jun 2021;15(3):192-217. Available from: https://www.journalofcardiovascularct.com/article/S1934-5925(20)30473-1/fulltext