Safety and feasibility of two-dimensional echocardiography and myocardial perfusion imaging in patients with chest pain

The accurate identification of patients at high risk for acute coronary syn dromes among those seen in the emergency department with possible myocardia l ischemia and nonischernic electrocardiograms is a problem. Two-dimensiona l echocardiography and myocardial perfusion imaging with 99m-technetium ses tamibi can identify patients at low and high risk; however, comparative stu dies are lacking. The authors studied 555 patients considered at low or mod erate risk for myocardial ischemia in our emergency department on the basis of the presenting history, and results of physical examination and electro cardiography. These patients underwent echocardiography and myocardial perf usion imaging within 4 hours of presentation. Endpoints included myocardial infarction, percutaneous transluminal coronary angioplasty, and positive r esults on stress perfusion imaging. Both imaging procedures were performed in the emergency department on 370 patients. Overall agreement between the two techniques was high (concordance, 89%) in the patients who had myocardi al infarction or underwent coronary angiography. Agreement between the two techniques is high when used in patients with possible myocardial ischemia. Both techniques helped identify patients at high risk who required admissi on and those who could be safely discharged.