Current and Future Applications of Coronary CT Angiography with and Without FFR in the Emergency Room

Multiple clinical trials have established the value of Coronary CT angiography (CCTA) for the evaluation of patients presenting to the ED with chest pain and a low to intermediate risk for acute coronary syndrome (ACS). CCTA can be used to evaluate these patients rapidly, effectively, and with relatively low cost and radiation dose. New research continues to accumulate, and despite much evidence to support its use in the ED setting, at least one recently published study has presented potentially contradictory results. Additionally, newer techniques that enhance the utility of CCTA, such as fractional flow reserve (FFR) and CT perfusion analysis have been developed and are becoming increasingly available. These applications provide important information about the hemodynamic significance of coronary lesions and are potentially useful in the ED setting to aid clinical decision making. This review provides an update on the literature related to the use of CCTA in the ED, including a discussion of emerging advanced cardiac CT applications.