TY - JOUR
T1 - Assessing risk in acute chest pain
T2 - The value of stress myocardial perfusion imaging in patients admitted through the emergency department
AU - Nabi, Faisal
AU - Chang, Su-Min
AU - Xu, Susan
AU - Gigliotti, Elizabeth
AU - Mahmarian, John J.
PY - 2012/4/1
Y1 - 2012/4/1
N2 - Background. To prospectively assess the clinical value of stress-gated myocardial single photon emission computed tomography (SPECT) for triaging patients admitted through the emergency department (ED) with acute chest pain (ACP). Methods. Prospective, observational cohort study in 1,576 consecutive patients who were evaluated for ACP over a 29-month period. Stress SPECT was performed within 24 hours of admission from the ED. Analysis included quantification of total and ischemic left ventricular perfusion defect size (PDS). Cardiac events were defined as an acute coronary syndrome during the index hospitalization or in follow-up over 7.3 ± 2.8 months. Results. Eighty-five cardiac events occurred in 77 patients (4.9%). SPECT was abnormal in 135 patients (8.6%) of whom 83 (61.5%) had a reversible defect. Event rates were significantly higher in patients with an abnormal (40%) versus a normal (1.6%) SPECT (P < .0001); and in those with a (1) large (<15%) versus small (≤15%) PDS (50.0% vs 33.7%, P = .05) and (2) large (<10%) versus small (≤10%) ischemic PDS (87.5% vs 42.4%, P < .0001, respectively). SPECT best predicted cardiac events by multivariate analysis. The addition of SPECT to clinical variables significantly improved overall risk prediction (global χ 2 103.6 vs 207.1, P < .001). Conclusions. Stress SPECT can accurately assess risk in a heterogeneous group of patients with ACP of unclear cardiac etiology, and beyond that provided by a clinical risk assessment alone. Our results support the use of stress SPECT for identifying very low-risk ACP patients with normal study results who can be safely discharged home.
AB - Background. To prospectively assess the clinical value of stress-gated myocardial single photon emission computed tomography (SPECT) for triaging patients admitted through the emergency department (ED) with acute chest pain (ACP). Methods. Prospective, observational cohort study in 1,576 consecutive patients who were evaluated for ACP over a 29-month period. Stress SPECT was performed within 24 hours of admission from the ED. Analysis included quantification of total and ischemic left ventricular perfusion defect size (PDS). Cardiac events were defined as an acute coronary syndrome during the index hospitalization or in follow-up over 7.3 ± 2.8 months. Results. Eighty-five cardiac events occurred in 77 patients (4.9%). SPECT was abnormal in 135 patients (8.6%) of whom 83 (61.5%) had a reversible defect. Event rates were significantly higher in patients with an abnormal (40%) versus a normal (1.6%) SPECT (P < .0001); and in those with a (1) large (<15%) versus small (≤15%) PDS (50.0% vs 33.7%, P = .05) and (2) large (<10%) versus small (≤10%) ischemic PDS (87.5% vs 42.4%, P < .0001, respectively). SPECT best predicted cardiac events by multivariate analysis. The addition of SPECT to clinical variables significantly improved overall risk prediction (global χ 2 103.6 vs 207.1, P < .001). Conclusions. Stress SPECT can accurately assess risk in a heterogeneous group of patients with ACP of unclear cardiac etiology, and beyond that provided by a clinical risk assessment alone. Our results support the use of stress SPECT for identifying very low-risk ACP patients with normal study results who can be safely discharged home.
KW - Acute chest pain
KW - Emergency department
KW - Risk assessment
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U2 - 10.1007/s12350-011-9484-7
DO - 10.1007/s12350-011-9484-7
M3 - Article
C2 - 22147618
AN - SCOPUS:84863455875
SN - 1071-3581
VL - 19
SP - 233
EP - 243
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
IS - 2
ER -