When a patient comes into an ER with chest pain, doctors have several options for screening. But Covid-19 made those options less desirable considering that medical staff were trying to limit everyone’s exposure to SARS-CoV-2, the virus that causes Covid-19. 

That’s where CCTA—coronary computed tomography angiography—can work wonders, explains Michael Poon, MD, professor of medicine, radiology, and emergency medicine at Northwell Greenwich Village Hospital (formerly Lenox Health Greenwich Village). “I was the first one in the United States who started the whole field of coronary CTA almost 20 years ago when I first saw some of the early images from a very simple scanner. I saw that this imaging had great opportunity and great potential.”

This quick diagnostic test produces a 3D image of the heart. In addition to spotting potential blockages in arteries, it can detect Covid-19 damage to the heart and lungs as well, says Dr. Poon.

“Coronary CTA can be used to rule out five potentially deadly conditions,” he explains. “The obstruction of the coronary artery, acute pulmonary embolism, dissecting aortic aneurysm, Covid lung infection, and acute inflammation of the heart muscle.”

Dr. Poon had already set up an outpatient clinic offering CCTA at Northwell Greenwich Village Hospital (formerly Lenox Health Greenwich Village) when the pandemic hit. He began using it to screen patients with potential Covid complications. All the test requires is an injection of contrast material and then a CT scan that’s over in just a fraction of a second.

“A lot of patients feel very surprised that it is so fast,” he says. 

Using CCTA, Dr. Poon was able to quickly spot—or rule out—Covid damage. What’s more, he was able to identify patients who needed emergency heart treatment. 

Other heart screens require more medical staff and take much longer to complete, notes Dr. Poon. As he screened more patients, he began to realize that the speed, accuracy, and ease of the CCTA makes it the perfect screening device for patients who have stable chest pain in the emergency room.

“I thought it was a great opportunity for CCTA to shine because it’s fast,” says Dr. Poon. “It does not require a lot of preparation, and it's noninvasive.” 

The CCTA’s advantages led Dr. Poon to collect his and colleagues’ experiences with CCTA and publish results in Radiology: Cardiothoracic Imaging. The paper makes the case for CCTA being the first test for patients with stable chest pain.

“We came up with a collective expert consensus that CCTA should be the first test.” 

In fact, the American Heart Association and the American College of Cardiology recently recognized CCTA as the most appropriate test to use first for evaluating stable chest pain in the US. This is a major change in the standard of care that resulted from the years of work and research that Dr. Poon has devoted to diagnosing heart disease.

“When someone comes in with chest pain and shortness of breath, many things can go wrong,” says Dr. Poon. “Now we have one single test that can point you in the right direction.”