Document Detail

Yield of early rest and stress myocardial perfusion single-photon emission computed tomography and electrocardiographic exercise test in patients with atypical chest pain, nondiagnostic electrocardiogram, and negative biochemical markers in the emergency department.
MedLine Citation:
PMID:  17560871     Owner:  NLM     Status:  MEDLINE    
There are no studies in which diagnostic yield of early rest myocardial perfusion gated single-photon emission computed tomography (SPECT), electrocardiographic exercise testing, and stress SPECT were compared in patients with atypical chest pain, nondiagnostic electrocardiograms (ECGs), and negative markers of myocardial damage in the emergency department. A prospective study of 96 patients who presented with atypical chest pain and nondiagnostic ECG, but without elevated markers of necrosis, was performed. All underwent rest gated SPECT using technetium-99m methoxyisobutyl isonitrile within 6 hours after pain subsided followed by an electrocardiographic exercise test to obtain stress-rest SPECT images. After 1 year, there were no deaths and coronary artery disease was confirmed in only 5 patients. Negative predictive values of the 3 techniques were high (99%, 96%, and 100%, respectively), but positive predictive values were low (27%, 22%, and 14%, respectively). Sensitivities of early SPECT (80%) and stress SPECT (100%) were higher than for the electrocardiographic exercise test (40%). In conclusion, in patients with atypical chest pain, nondiagnostic ECG, and negative biochemical markers, negative predictive values of the 3 tests analyzed are very high. The sensitivity of radionuclide tests is higher, but their widespread use does not appear warranted because their positive predictive value and incidence of complications is low.
Jaume Candell-Riera; Guillermo Oller-Martínez; Gustavo de León; Joan Castell-Conesa; Santiago Aguadé-Bruix
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-05-04
Journal Detail:
Title:  The American journal of cardiology     Volume:  99     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-11     Completed Date:  2007-09-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1662-6     Citation Subset:  AIM; IM    
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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MeSH Terms
Biological Markers / blood
Chest Pain / diagnosis*
Echocardiography, Stress*
Emergency Service, Hospital
Exercise Test
Middle Aged
Necrosis / blood
Prospective Studies
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon*
Reg. No./Substance:
0/Biological Markers; 109581-73-9/Technetium Tc 99m Sestamibi

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