• ST-elevation may represent STEMI or other alternative diagnoses (e.g., aortic dissection)
• Computed tomographic (CT) scanning may help in identifying these alternative diagnoses
• ACTIVATE-SF Registry consists of patients w/a Dx of STEMI admitted to the ED 
• 410 patients w/a suspected diagnosis of STEMI, 45 (11%) underwent CT scanning before primary PCI; 2 (4%) of these CT scans changed clinical management by identifying a stroke
• Those who underwent CT scanning had far longer door-to-balloon times (median 166 vs 75 minutes, p <0.001) and higher in-hospital mortality (20% vs 7.8%, p=0.006)
• CT scanning before PCI rarely changed management and was associated w/significant delays in door-to-balloon times

References

 Armstrong E, MD, Kulkarni A, Hoffmayer K, et al. Am J Cardiol 2012;110: 345–349