The cost implications of potentially discharging patients from the ED that are found to be free of CAD without further testing are impressive. In May of 2008, data in abstract form were presented in Academic EM where authors reported good NPV in 568 prospective patients who received coronary CTA in the ED at 30-days. These reports lacked a description of design, methodology, and a stated power calculation of an a priori hypothesis. Thus, the need for more definitive apriori cost and outcome clinical research in the application of coronary CTA in acute chest pain is warranted. The effect of this work will define and change the clinical practice landscape when applying this innovation to the cardiac risk-stratification model, particularly in acutely presenting chest pain. Embracing the incorporation of coronary CTA in acute chest pain is an innovation that will require well performed clinical trials to define the patients who will benefit most; whether it should be applied to asymptomatic patients, low, intermediate, and/or high-risk acute chest pain patients remains the question.