Diagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department

Diagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department Camilo Fernández Bravo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6559713/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Acute undifferentiated chest pain (AUCP) is a frequent and diagnostically challenging presentation in emergency departments (EDs), encompassing life-threatening conditions such as acute coronary syndrome (ACS), pulmonary embolism (PE), aortic dissection (AD), and other non-cardiac etiologies. Comprehensive cardiothoracic computed tomography (CCT), including coronary computed tomography angiography (CCTA) and non-coronary thoracic imaging, has revolutionized the diagnostic approach to AUCP. This review evaluates the diagnostic accuracy, clinical utility, prognostic value, and cost-effectiveness of CCT in the ED, emphasizing its role in rapid risk stratification, reducing unnecessary hospitalizations, and guiding therapeutic decisions. We synthesize evidence from 2015–2025 studies to highlight CCT’s strengths, limitations, and emerging applications. While CCT offers high sensitivity and negative predictive value (NPV), considerations such as radiation exposure, contrast-related risks, and resource availability necessitate judicious use. CCT is a cornerstone of modern ED diagnostics, with potential to optimize patient outcomes through precise and timely management. Cardiac & Cardiovascular Systems Acute chest pain cardiothoracic computed tomography coronary computed tomography angiography emergency department diagnostic accuracy risk stratification Full Text Additional Declarations The authors declare potential competing interests as follows: Dr. Camilo Fernández Bravo declares the following affiliations that may be perceived as potential competing interests: He obtained his MD degree from the Universidad de Ciencias Médicas de Camagüey “Carlos J. Finlay” in Cuba. He completed his residency in Internal Medicine and Cardiology in Brazil. He holds a certification in Cardio-Oncology and has participated in clinical and academic cardiology practice in both Cuba and Brazil. These affiliations may be perceived to influence the interpretation or discussion presented in this preprint. All relevant affiliations have been transparently disclosed. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6559713","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449909464,"identity":"41aba82d-6457-440a-96d5-8d7da966219c","order_by":0,"name":"Camilo Fernández Bravo","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0004-6848-7115","institution":"UCM Carlos J Finlay","correspondingAuthor":true,"prefix":"","firstName":"Camilo","middleName":"Fernández","lastName":"Bravo","suffix":""}],"badges":[],"createdAt":"2025-04-29 22:53:56","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6559713/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6559713/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81794461,"identity":"d2bdd08c-f675-4852-acd9-b828ee77ebaf","added_by":"auto","created_at":"2025-05-02 02:58:54","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":210603,"visible":true,"origin":"","legend":"","description":"","filename":"DiagnosticProcedures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6559713/v1_covered_3cab1dfd-7a27-4e2b-bd87-82eded0d165a.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: Dr. Camilo Fernández Bravo declares the following affiliations that may be perceived as potential competing interests: He obtained his MD degree from the Universidad de Ciencias Médicas de Camagüey “Carlos J. Finlay” in Cuba. He completed his residency in Internal Medicine and Cardiology in Brazil. He holds a certification in Cardio-Oncology and has participated in clinical and academic cardiology practice in both Cuba and Brazil. These affiliations may be perceived to influence the interpretation or discussion presented in this preprint. All relevant affiliations have been transparently disclosed.","formattedTitle":"\u003cp\u003eDiagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"UCM Carlos J Finlay","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute chest pain, cardiothoracic computed tomography, coronary computed tomography angiography, emergency department, diagnostic accuracy, risk stratification","lastPublishedDoi":"10.21203/rs.3.rs-6559713/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6559713/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAcute undifferentiated chest pain (AUCP) is a frequent and diagnostically challenging presentation in emergency departments (EDs), encompassing life-threatening conditions such as acute coronary syndrome (ACS), pulmonary embolism (PE), aortic dissection (AD), and other non-cardiac etiologies. Comprehensive cardiothoracic computed tomography (CCT), including coronary computed tomography angiography (CCTA) and non-coronary thoracic imaging, has revolutionized the diagnostic approach to AUCP. This review evaluates the diagnostic accuracy, clinical utility, prognostic value, and cost-effectiveness of CCT in the ED, emphasizing its role in rapid risk stratification, reducing unnecessary hospitalizations, and guiding therapeutic decisions. We synthesize evidence from 2015–2025 studies to highlight CCT’s strengths, limitations, and emerging applications. While CCT offers high sensitivity and negative predictive value (NPV), considerations such as radiation exposure, contrast-related risks, and resource availability necessitate judicious use. CCT is a cornerstone of modern ED diagnostics, with potential to optimize patient outcomes through precise and timely management.\u003c/p\u003e","manuscriptTitle":"Diagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-02 02:50:48","doi":"10.21203/rs.3.rs-6559713/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d544c258-aa52-4ad4-a93a-c346ff323be5","owner":[],"postedDate":"May 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47876486,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2025-05-02T02:50:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-02 02:50:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6559713","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6559713","identity":"rs-6559713","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}