Document Detail


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.
MedLine Citation:
PMID:  8799249     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
T C Hilton; H Fulmer; T Abuan; R C Thompson; S A Stowers
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  1996-10-28     Completed Date:  1996-10-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  308-11     Citation Subset:  IM    
Affiliation:
Department of Nuclear Medicine, St. Luke's Hospital, Jacksonville, Fla., USA.
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MeSH Terms
Descriptor/Qualifier:
Angina Pectoris / 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:
109581-73-9/Technetium Tc 99m Sestamibi

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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