Document Detail


Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain.
MedLine Citation:
PMID:  19772587     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients.
METHODS: We studied 103 patients, mean 56.7 + or - 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization.
RESULTS: In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary end-point during follow-up. The negative predictive value of AS-CMR was 100%.
CONCLUSION: AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.
Authors:
Stamatios Lerakis; Dalton S McLean; Athanasios V Anadiotis; Matthew Janik; John N Oshinski; Nikolaos Alexopoulos; Elisa Zaragoza-Macias; Emir Veledar; Arthur E Stillman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-09-21
Journal Detail:
Title:  Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance     Volume:  11     ISSN:  1532-429X     ISO Abbreviation:  J Cardiovasc Magn Reson     Publication Date:  2009  
Date Detail:
Created Date:  2009-10-08     Completed Date:  2009-12-02     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  9815616     Medline TA:  J Cardiovasc Magn Reson     Country:  England    
Other Details:
Languages:  eng     Pagination:  37     Citation Subset:  IM    
Affiliation:
Department of Medicine and Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road NE, Suite AT-500-508, Atlanta GA, 30322, USA. sleraki@emory.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / complications,  diagnosis*,  mortality
Adenosine / diagnostic use*
Adult
Aged
Angina Pectoris / diagnosis*,  etiology,  mortality
Chest Pain / diagnosis*,  etiology,  mortality
Coronary Stenosis / complications,  diagnosis*,  mortality,  therapy
Female
Humans
Magnetic Resonance Imaging, Cine*
Male
Middle Aged
Myocardial Infarction / diagnosis,  etiology,  therapy
Myocardial Revascularization
Patient Discharge
Patient Readmission
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Time Factors
Chemical
Reg. No./Substance:
58-61-7/Adenosine
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