In the United States, chest pain is the second leading reason for patients to present to an emergency department (ED). Previously, those patients suspected to have acute coronary syndrome were monitored for 24 hours to determine the presence of serum biomarkers consistent with myocardial injury. However, more recently, imaging has been used to more efficiently triage these individuals and even discharge them directly from the ED. There are multiple cardiac imaging modalities; however, cardiac computed tomography now plays a significant role in the evaluation of patients with suspected acute coronary syndrome who present to the ED. In this review, we discuss the available state-of-the-art techniques for evaluating this cohort of patients, including clinical evaluation, serum biomarkers, and imaging options. Further, we analyze in detail evidence for the use of coronary computed tomography angiography to determine whether these patients can safely be discharged from the ED. Finally, we review some of the related future techniques that may become part of the accepted clinical management of these patients in the future.