Usefulness of two-dimensional echocardiography and myocardial perfusion imaging for immediate evaluation of chest pain in the emergency department

Background: Accurate identification of patients in the emergency department at high risk of acute coronary syndrome with possible myocardial ischaemia and a nonischaemic electrocardiogram is problematic. Both two-dimensional echocardiography and myocardial perfusion imaging with technetium-99m-sesta mibi can identify patients at low and high risk. however comparative studie s are lacking.;Methods and results: We studied 655 consecutively patients c onsidered at low or moderate risk for myocardial ischaemia in our Emergency Department (ED). On the basis of the presenting history, physical examinat ion, and electrocardiogram they underwent both echocardiography and myocard ial perfusion imaging within 4 h of ED presentation. End points included my ocardial infarction, percutaneous transluminal coronary angioplasty (PTCA) and positive stress perfusion imaging. Both imaging procedures were perform ed in the ED on 470 patients. Overall agreement between the two techniques was high (concordance 90%) in the patients who had myocardial infarction or underwent coronary angiography. Conclusions: Agreement between the two ima ging techniques is high when used in patients with possible myocardial isch aemia. Both techniques identified patients at high risk who required admiss ion and those who could be safely discharged directly from the ED. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.