VALUE OF ACUTE REST SESTAMIBI PERFUSION IMAGING FOR EVALUATION OF PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN

Objectives. This study sought to determine the ability of early perfus ion imaging using technetium-99m sestamibi to predict adverse cardiac outcomes in patients who present to the emergency department with poss ible cardiac ischemia and nondiagnostic electrocardiograms (ECGs). Bac kground. Evaluation of patients presenting to the emergency department with possible acute coronary syndromes and nondiagnostic ECGs is prob lematic. Accurate risk stratification is necessary to prevent serious adverse outcomes, Initial results suggest that early perfusion imaging using technetium-99m sestamibi enables reliable risk stratification. Methods. Patients presenting to the emergency department with a low to moderate probability of acute coronary syndromes underwent rapid sest amibi injection with gated single-photon emission computed tomographic imaging. Studies shelving perfusion defects with associated wall moti on abnormalities were considered positive. Results. A total of 532 con secutive patients underwent serial myocardial marker analysis and rest perfusion imaging. Of these patients, perfusion imaging was positive in 171 (32%). Positive perfusion imaging was the only multivariate pre dictor of myocardial infarction (MI) (p < 0.0001, odds ratio [OR] 33, 95% confidence interval [CI] 7.7 to 141) and,vas the most important in dependent predictor of MI or revascularization (p < 0.0001, OR 14, 95% CI 7.3 to 25), followed by diabetes (p < 0.01, OR 2.8, 95% CI 1.5 to 5.1), typical angina (p = 0.01, OR 2.1, 95% CI 1.2 to 3.7) and male ge nder (p = 0.03, OR 1.9, 95% CI 1.1 to 3.5). The sensitivity of positiv e perfusion imaging for MI was 93% (95% CI 77% to 98%), and for MI or revascularization it was 81% (95% CI 71% to 88%), with negative predic tive values of 99% (95% CI 98% to 100%) and 95% (95% CI 92% to 97%), r espectively. Conclusions. Positive rest perfusion imaging accurately i dentified patients at high risk for adverse cardiac outcomes, whereas negative perfusion imaging identified a low risk patient group. Early perfusion imaging allows for rapid and accurate risk stratification of emergency department patients with possible cardiac ischemia and nond iagnostic ECGs. (C) 1997 by the American College of Cardiology.