SCCT: CT-first imaging protocol could transform chest pain evaluation

Cardiac CT -- particularly coronary CT angiography (CCTA) -- is reshaping the diagnostic pathway for patients with chest pain, according to a presentation delivered February 18 at a webinar hosted by the Society for Cardiovascular Computed Tomography (SCCT).

CCTA is shifting from a secondary or confirmatory test to a first‑line diagnostic tool, especially in urgent care settings, noted presenter Sujith Kalathiveetil, MD, a cardiologist at Duly Health and Care in Chicago, IL. The webinar was sponsored by Arineta.

Sujith Kalathiveetil, MD, of Duly Health and Care in Chicago, IL.SCCT

Kalathiveetil explained that typical approaches to assessing chest pain rely on risk-factor profiles, functional testing, or immediate referral to emergency departments -- all of which are methods that can result in unnecessary hospital admissions and delayed diagnoses. 

In contrast, using CT imaging first to assess chest pain can translate to earlier, more accurate identification of coronary artery disease (CAD), allowing clinicians to visualize plaque burden directly rather than evaluating risk through indirect means, he said. 

He noted that a shift to using CCTA for chest pain assessment has been supported by professional society guidelines such as those from the American College of Cardiology and the American Heart Association that recognize CCTA as a class I recommendation for evaluating stable chest pain in patients without known obstructive CAD.

CCTA has particular value in urgent care environments, and a CT‑first protocol streamlines patient triage so that instead of default referrals to emergency departments, patients with non–life‑threatening symptoms can undergo same‑day imaging that can quickly differentiate between benign and potentially serious cardiac conditions -- which not only improves clinical accuracy but also reduces healthcare costs and enhances patient satisfaction, Kalathiveetil noted.

In fact, Duly Health and Care created what it calls a Cardiac Evaluation Center (CEC) for patients with non-life-threatening cardiac symptoms (including chest pain) to provide rapid evaluation and onsite testing. The center installed an Arineta SpotLight CT scanner in 2022, he said.

The takeaway? Integrating CCTA as a first‑line tool is not just a technological upgrade but a paradigm shift in how clinicians evaluate chest pain, detect atherosclerosis early, and deliver timely, personalized cardiovascular care, Kalathiveetil concluded.