EMERGENCY ROOM TC-99M SESTAMIBI IMAGING TO RULE OUT ACUTE MYOCARDIAL ISCHEMIC EVENTS IN PATIENTS WITH NONDIAGNOSTIC ELECTROCARDIOGRAMS

Objectives. The goal of this study was to determine the role of nuclea r imaging in patients with chest pain. Background. The diagnosis of my ocardial ischemic events in patients with chest pain and a nondiagnost ic electrocardiogram (ECG) is problematic. Methods. Rest tomographic t echnetium-99m sestamibi imaging (740 MBq intravenously) was performed in 64 patients presenting to the emergency room with chest pain of sus pected cardiac origin and a nondiagnostic ECG. Patients were admitted to the coronary care unit on the basis of clinical criteria only and w ere strictly monitored. Results. Thirty patients showed a perfusion de fect on admission. Of these, 13 developed myocardial infarction within 12 h. Coronary artery disease was diagnosed in 14 patients and the re maining 3 patients were classified as having false positive findings. Normal perfusion scans were seen in 34 patients, none of whom were ult imately diagnosed as having coronary artery disease. A 100% sensitivit y was demonstrated versus the final diagnosis of acute cardiac ischemi a (kappa 0.91, 95% confidence interval 0.8 to 1.0). A follow-up period of up to 18 months (mean 11 +/- 3) was also carried out for major car diac events (death, myocardial infarction, coronary angioplasty and co ronary artery bypass grafting). Six events (two coronary bypass proced ures, three angioplasty procedures and one death) were observed at fol low-up in the group of patients with a technetium-99m sesta-mibi perfu sion defect. Patients with normal perfusion scans on admission had no major cardiac events at follow-up study. Conclusions. Technetium-99m s estamibi perfusion imaging is a promising technique for ruling out acu te myocardial ischemia in the emergency roam. More efficient utilizati on of intensive therapy beds may be expected with this approach.