- 作者：William L. Duvall ; MD&lowast ; ; ; Melanie N. Wijetunga ; MD&dagger ; ; Thomas M. Klein ; MD&dagger ; ; Rittu Hingorani ; MS&dagger ; ; Benoit Bewley ; MD&dagger ; ; Shahid M. Khan ; MD&Dagger ; ; Luke K. Hermann ; MD§ ; ; Milena J. Henzlova ; MD&lowast ;
- 关键词：emergency department ; stress testing ; myocardial perfusion imaging ; prognosis
- 刊名：Journal of Emergency Medicine
- 出版年：2012
- 期刊代码：156_07364679
- 类别：med
- 出版时间：June, 2012
- 卷：42
- 期：6
- 页码：642-650
- 文件大小：400 K
Background
Stress-only myocardial perfusion imaging (MPI) saves time by eliminating rest imaging, which is important for emergency department (ED) throughput but has not been studied in an ED population.Study Objective
To determine the prognosis of a normal stress-only MPI study compared to a normal rest-stress MPI and establish its effectiveness in an ED setting.
Methods
All patients evaluated in the ED over 6.5 years who underwent a stress-only technetium-99m gated MPI were compared to those who had a rest-stress study. All-cause mortality was determined using the Social Security Death Index. Survival was analyzed in patients with normal and abnormal MPI results.
Results
A total of 4145 studies (2340 stress-only, 1805 rest-stress) were performed. Patients鈥?average age was 57.9 years, 38.5%were male, and most had an intermediate or low pretest risk of coronary artery disease (87.7%). Average follow-up was 35.9 卤 20.9 months. In patients with normal perfusion, at 1 year of follow-up there were 11 deaths in the stress-only group (0.5%1-year mortality), and 13 deaths in the rest-stress cohort (1.1%1-year mortality). At the end of follow-up, the stress-only group had a lower all-cause mortality (
Conclusions
A normal stress-only MPI study has a benign 1-year prognosis similar to a rest-stress study when performed in the ED. The ability to triage patients more rapidly and reduce radiation exposure represents an attractive alternative for low-risk patients.