Stress-Only Tc-99m Myocardial Perfusion Imaging in an Emergency Department Chest Pain Unit

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• 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

摘要

ass="h4">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.

ass="h4">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.

ass="h4">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.

ass="h4">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 (p < 0.0001) and similar risk adjusted all-cause mortality (p = 0.10) than the rest-stress cohort. Patients with abnormal perfusion demonstrated the expected differential prognosis based on total perfusion deficits in both groups.

ass="h4">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.