Acute chest pain is one of the most common reasons for Emergency Department (ED) visits
and hospital admissions. As this could represent the first symptom of a lifethreatening
condition, urgent identification of the etiology of chest pain is of utmost importance
in emergency settings. Such high-risk conditions that can present with acute chest
pain in the ED include Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and
Acute Aortic Syndromes (AAS).The concept of Triple Rule-out Computed Tomographic Angiography
(TRO-CTA) for patients presenting with acute chest pain in the ED is based on the
use of coronary computed tomographic angiography as a single imaging technique, able
to diagnose or exclude three lifethreatening conditions in one single step: ACS, AAS
and PE. TRO-CTA protocols have been proved to be efficient in the ED for diagnosis
or exclusion of life-threatening conditions and for differentiation between various
etiologies of chest pain, and application of the TRO-CTA protocol in the ED for acute
chest pain of uncertain etiology has been shown to improve the further clinical evaluation
and outcomes of these patients.This review aims to summarize the main indications
and techniques used in TRO protocols in EDs, and the role of TRO-CTA protocols in
risk stratification of patients with acute chest pain.