| Ninety-day follow-up of patients in the emergency department with chest pain who undergo initial single-photon emission computed tomographic perfusion scintigraphy with technetium 99m-labeled sestamibi. | |
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MedLine Citation:
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PMID: 8799249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients in the emergency department with typical chest pain and a normal or nondiagnostic electrocardiogram have a 10% to 20% risk of nonfatal myocardial infarction. These patients can be stratified into groups of very low and very high risk for inpatient adverse cardiac events on the basis of initial 99mTc-labeled sestamibi single-photon emission computed tomographic (SPECT) perfusion imaging performed during symptoms. However, the intermediate or posthospital discharge prognosis of such patients has not been reported. METHODS AND RESULTS: Patients (n = 150) with typical chest pain (based on a semiquantitative chest pain questionnaire) and a normal or nondiagnostic electrocardiogram underwent injection of 15 to 45 mCi 99mTc-labeled sestamibi injected during symptoms. Ninety-day follow-up history (telephone questionnaire and review of medical records) was obtained in 140 patients, and follow-up electrocardiography was performed in 72 patients. Cardiac events (death, nonfatal myocardial infarction, thrombolysis, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting) occurred before hospital discharge in 33 patients (18%), and these patients were excluded from further analysis. At follow-up, two (8%) of 25 patients with an abnormal initial scintigram and none of 87 patients with a normal scan had cardiac events (p = 0.008). CONCLUSIONS: In patients with typical angina and a normal or nondiagnostic electrocardiogram, initial SPECT scintigraphy allows early accurate risk stratification. The previously observed excellent inpatient prognosis of patients with a normal scintigram appears to extend for at least 90 days of follow-up. These observations may provide a rational basis for safe and cost-effective outpatient evaluation of selected patients in the emergency department with typical angina, a normal or nondiagnostic electrocardiogram, and a normal initial 99mTc-labeled SPECT perfusion scintigram performed during symptoms. |
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Authors:
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T C Hilton; H Fulmer; T Abuan; R C Thompson; S A Stowers |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology Volume: 3 ISSN: 1071-3581 ISO Abbreviation: J Nucl Cardiol Publication Date: 1996 Jul-Aug |
Date Detail:
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Created Date: 1996-10-28 Completed Date: 1996-10-28 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9423534 Medline TA: J Nucl Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 308-11 Citation Subset: IM |
Affiliation:
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Department of Nuclear Medicine, St. Luke's Hospital, Jacksonville, Fla., USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angina Pectoris
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radionuclide imaging* Chest Pain Electrocardiography Emergency Service, Hospital Female Follow-Up Studies Heart / radionuclide imaging* Humans Male Middle Aged Prognosis Risk Factors Technetium Tc 99m Sestamibi / diagnostic use* Tomography, Emission-Computed, Single-Photon* |
| Chemical | |
Reg. No./Substance:
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109581-73-9/Technetium Tc 99m Sestamibi |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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