Objective. Patients presenting to the emergency department with chest pain who are not clearly having an acute ischemic event are often admitted for observation and testing. In this observational study, we determined the effect of having access to very early myocardial perfusion imaging on the hospital course of patients presenting with chest pain. Methods. Patients presenting to the emergency department for evaluation of chest pain, which raised suspicion of coronary disease, were followed. Patients with ECG evidence of prior Q wave myocardial infarction, or an elevation of CK-MB #1, were not included in the study. Myocardial perfusion imaging (either with exercise or dipyridamole infusion) was performed at the request of the patient's cardiologist and upon laboratory availability; the protocol included an initial rest image, with exclusion from stress testing if an abnormality was seen. Two groups were followed: Group 1 (n =54) included patients who had imaging; four patients had an abnormal test and were excluded from further analysis. Group 2 (n = 25) included patients in whom the imaging study was requested, but could not be done because the laboratory was unable to accommodate the test. Patients were subsequently followed for 2 years for clinical events, including death, myocardial infarction, myocardial revascularization (percutaneous transluminal coronary angioplasty or coronary artery bypass graft), as well as repeat stress testing. Results. There was no significant difference between the groups with respect to presenting characteristics or laboratory tests. The mean length of hospital stay of patients in Group 1 (13.3 ± 1.0 hours) was significantly lower (p < 0.001) than for Group 2 (50.8 ± 6.1 hours). In addition, the mean hospital costs were significantly lower (p = 0.026) in Group 1 ($1,609.96 ± $139.05) than for Group 2 ($2,579.79 ± $388.97). In Group 2, 17/25 had stress testing prior to discharge - all were negative. Follow-up of 71 of the 75 patients (95%) with a negative rest image 2 years after the conclusion of the study revealed: 1) one (1.4%) cardiac catheterization showing normal coronary arteries; 2) one (1.4%) repeat nuclear perfusion imaging study, which was negative; and 3) one (1.4%) death due to cancer. Conclusion. Very early stress myocardial perfusion imaging of selected patients presenting to the emergency department with chest pain is safe and may impact hospital length of stay and hospital costs.
|Original language||English (US)|
|Journal||Cardiovascular Reviews and Reports|
|State||Published - Jan 1 2001|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine