Keywords
1. Acute Rest Myocardial Perfusion Imaging
Chest Pain
Coronary Artery Disease
Acute Coronary Syndrome
Emergency Department
Chest Pain
Coronary Artery Disease
Acute Coronary Syndrome
Emergency Department
How to Cite
Molina, I. L., Escabí-Mendoza, J., Santiago-Delgado, B., Aponte-Rodríguez, J., & Turull, M. J. (2016). Impact of Rest Myocardial Perfusion Imaging on Clinical Management of Non-High Risk Chest Pain in the VA Caribbean Healthcare System Emergency Department: 2006-2008. Puerto Rico Health Sciences Journal, 35(1). Retrieved from https://prhsj.rcm.upr.edu/index.php/prhsj/article/view/1190
Abstract
Objective: To evaluate the appropriate clinical use of an acute rest myocardial perfusion imaging (R-MPI) in the initial emergency department (ED) evaluation of a patient presenting with chest pain (CP). Methods: This is a retrospective study of patients evaluated with CP at the ED with an acute R-MPI. The data collected included medical history, clinical presentation, electrocardiogram, laboratory data, MPI results, confirmatory studies, disposition diagnosis and cost analysis. Results: Three-hundred-sixty-six (366) patients were evaluated. The population studied had a mean Thrombolysis in Myocardial Infarction (TIMI) score of 2 and predominance of patients in the Virginia Commonwealth University (VCU) CP Category-Scale between level 3 and 4 (34% and 49% respectively). The risk of acute coronary syndrome (ACS) was significantly higher in patients with abnormal compared to normal studies (50% versus 0.4%; P < .0005; RR, 129.5; 95% CI, 18 to 924). There were a total of 14 and 19 major adverse cardiovascular events (MACE) events during the follow-up of 30-days and 1-year respectively. There were no cardiovascular fatalities. The risk of MACE at 30-days was significantly higher in patients with abnormal compared to normal studies (12% versus 0.4%; P < .001; RR, 32; 95% CI, 4.2 to 240), as well as with 1-year of follow-up (14% versus 1.6%; P < .001; RR, 9.1; 95% CI, 3.1 to 27). Conclusion: Using acute R-MPI in the evaluation of non-high risk patients presenting with CP is a safe, reliable and cost-effective strategy to be used in the ED to predict ACS and future MACE.
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