Multiple small trials comparing coronary CTA with invasive coronary angiography have demonstrated sensitivities ranging from 86-99% and specificities ranging from 93-97% for the detection of hemodynamically significant CAD. The negative predictive value (NPV) of coronary CTA in these studies was uniformly high, ranging from 95-99%, while rates of non-evaluable segments were low, ranging from 0-12%23, 30-34. Results of the multicenter, international CORE-64 trial were discussed at the 2007 American Heart Association Scientific Sessions evaluating the diagnostic performance of coronary CTA as compared with interventional coronary angiography in 291 patients with suspected or known CAD and Agatston calcium score <600. On a per patient basis, the sensitivity and specificity of coronary CTA for detection of significant CAD were 85% and 90%, while positive and NPV were 91% and 83%35. Moreover, in 2007, Meijboom et al36 reported on the utility of the coronary CTA in symptomatic patients with low, intermediate, or high estimated pretest probability of having significant CAD. Of the 254 patients enrolled in the study, the authors determined that all of the patients in both the low and intermediate-risk groups that were found to not have disease by coronary CTA were later determined to not have disease by invasive coronary angiography. Patients presenting to the ED with acute chest pain could potentially undergo more rapid triage with coronary CTA, speeding diagnosis, lowering hospital and further cost of testing.