Safe to Discharge Patients Based Upon Negative Coronary CTA

Background: Prior studies have demonstrated that coronary CT angiography (CCTA) has a negative predictive value of almost 100% for coronary artery disease. Objective: To evaluate whether one can discharge patients presenting with chest pain from the emergency department (ED) safely based on a negative CCTA. Design: Randomized controlled multicenter trial. Participants: 1370 patients were randomly assigned to CCTA (908) versus traditional care (462). All patients were at least 30 years old and had symptoms/signs suggesting possible acute coronary syndrome. The presenting ECG did not demonstrate acute ischemia, and they had an initial Thrombolysis in Myocardial Infarction risk score of 0 to 2. Methods: The authors hypothesized that patients with no coronary stenosis ≥50% on CCTA would have a 30-day rate of myocardial infarction or cardiac death of Results: Of 640 patients who had a negative CCTA, 0 had a myocardial infarction or died within 30 days. Patients in the CCTA group had a more...