Search

Background: Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes.Methods: Serum markers and acute technetium-99m sestamibi/tetrofosmin rest MPI were obtained in 75 patients admitted to the ED with chest pain and nondiagnostic electrocardiograms. Venous samples were drawn at admission and 8 to 24 hours later for total creatine kinase, CK-MB fraction, troponin T, troponin I, and myoglobin. Three nuclear cardiologists performed blinded image interpretation. Coronary artery disease (CAD) was confirmed either by diagnostic testing or by the occurrence of myocardial infarction (MI).Results: Acute rest MPI results were abnormal in all 9 patients with MI. An additional 26 patients had objective evidence of CAD confirmed by diagnostic testing. The sensitivity of acute rest MPI for objective evidence of CAD was 73%. Serum troponin T and troponin I were highly specific for acute MI but had low sensitivity at presentation. Individual serum markers had very low sensitivity for symptomatic myocardial ischemia alone. In the multivariate regression model, only acute rest MPI and diabetes were independently predictive of CAD.Conclusion: At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers. [ABSTRACT FROM AUTHOR]

With jeopardized viable myocardium in the distributions of the left anterior descending and right coronary arteries, it was decided to perform bypass surgery. Saphenous venous bypass grafts were placed to the left anterior descending, right and obtuse marginal coronary arteries. The patient had an uneventful postoperative course and was discharged. The case shows how nuclear myocardial perfusion imaging can be a useful adjunct in the clinical decision-making process when coronary anatomy reveals occlusion of one or more arteries associated with severe regional wall motion abnormalities suggesting scar. In this case, if only the angiographic and echocardiographic data had been evaluated, the inferior wall would have been assessed as nonviable and might not have been revascularized. The perfusion imaging, however, clearly defined persistent jeopardized viable myocardium involving the inferior wall as well as in the left anterior descending artery territory. This allowed the patient to have complete revascularization. [ABSTRACT FROM AUTHOR]

We analyzed potential gender differences in the use and prognostic value of stress technetium 99m sestamibi tomography, image results, and cardiac event rates over a period of 15 +/- 8 months in 1226 men and 1151 women. Men had more abnormal tomographic images, but referral for catheterization and revascularization similarly increased in relation to the number of defects. Men and women with abnormal images had similar event rates, 19.6% and 18.2%, respectively, although men more often had myocardial infarction or cardiac death (7.6% vs 4.1 %, p < 0.05), whereas women had an increased likelihood of unstable angina or congestive heart failure (11.5% vs 7.6%, p < 0.05). Normal images predicted a low yearly rate of myocardial infarction or death: 1.7% for men and 0.8% for women. Image findings, particularly defect extent, were independent predictors of events in both groups. Thus, after stress Tc-99m sestamibi single-photon emission computed tomography perfusion imaging, there was no gender bias in referral for invasive procedures, and for both men and women image findings were strongly associated with prognostic outcome.