We have located links that may give you full text access.
COMPARATIVE STUDY
JOURNAL ARTICLE
RESEARCH SUPPORT, NON-U.S. GOV'T
Selective dual nuclear scanning in low-risk patients with chest pain to reliably identify and exclude acute coronary syndromes.
Annals of Emergency Medicine 2001 September
STUDY OBJECTIVE: We sought to determine the use in routine clinical practice of selective dual nuclear cardiac scanning (rest and stress) in low-risk patients with chest pain for identifying and excluding acute coronary syndromes (ACSs) during the initial emergency department evaluation.
METHODS: A prospective observational study was conducted over 13 months in 1,775 low-risk patients with chest pain who had intermediate- and high-risk ACSs ruled out by means of our 2-hour protocol, which consists of automated serial 12-lead ECG monitoring in conjunction with baseline and 2-hour creatine kinase (CK) MB and troponin I (cTnI) measurements. At the completion of the 2-hour evaluation period, low-risk patients were stratified by means of physician judgment into 1 of 2 categories: category III, possible ACS; and category IV, probable non-ACS chest pain. Level III patients underwent immediate dual nuclear scanning (rest thallium and stress sestamibi scanning), and level IV patients were discharged directly from the ED unless another serious non-ACS medical condition was thought to exist. Rest and stress scans were interpreted by a board-certified radiologist contemporaneous with patient evaluation. All patients were followed up for 30-day ACS, which was defined as acute myocardial infarction, percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, coronary arteriography revealing stenosis of the major coronary artery of 70% or greater not amenable to percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, life-threatening complication, or cardiac death within 30 days of ED presentation.
RESULTS: A total of 2,206 ED patients with chest pain were evaluated for ACS during the study period. Four hundred thirty-one patients were excluded for having 1 or more of the following findings: initial ECG diagnostic of injury; baseline CK-MB level, cTnI level, or both diagnostic of acute myocardial infarction; 2-hour DeltaCK-MB level of +1.5 ng/mL or greater; 2-hour DeltacTnI level of +0.2 ng/mL or greater; injury or new or evolving ischemia on serial 12-lead ECG monitoring; or clinical diagnosis of ACS. Of the 1,775 study patients, 805 (45.4%) underwent immediate dual nuclear scanning. A positive stress nuclear scan result was more sensitive (97.3% versus 71.2%, P <.0001) and specific (87.7% versus 72.6%, P <.0001) for 30-day ACS than a positive resting nuclear scan result. The protocol of selective dual nuclear scanning (ie, patients who did not undergo dual nuclear scanning were counted as having a negative test result) had a sensitivity and specificity for 30-day ACS of 93.4% and 94.7%, respectively (positive likelihood ratio 17.6; negative likelihood ratio 0.07).
CONCLUSION: Stress nuclear scanning is more sensitive and specific than resting nuclear scanning for identification of ACS in low-risk patients with chest pain. A strategy of using selective dual nuclear scanning once high- and intermediate-risk ACS has been ruled out with our 2-hour evaluation both reliably identifies and reliably excludes 30-day ACS.
METHODS: A prospective observational study was conducted over 13 months in 1,775 low-risk patients with chest pain who had intermediate- and high-risk ACSs ruled out by means of our 2-hour protocol, which consists of automated serial 12-lead ECG monitoring in conjunction with baseline and 2-hour creatine kinase (CK) MB and troponin I (cTnI) measurements. At the completion of the 2-hour evaluation period, low-risk patients were stratified by means of physician judgment into 1 of 2 categories: category III, possible ACS; and category IV, probable non-ACS chest pain. Level III patients underwent immediate dual nuclear scanning (rest thallium and stress sestamibi scanning), and level IV patients were discharged directly from the ED unless another serious non-ACS medical condition was thought to exist. Rest and stress scans were interpreted by a board-certified radiologist contemporaneous with patient evaluation. All patients were followed up for 30-day ACS, which was defined as acute myocardial infarction, percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, coronary arteriography revealing stenosis of the major coronary artery of 70% or greater not amenable to percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, life-threatening complication, or cardiac death within 30 days of ED presentation.
RESULTS: A total of 2,206 ED patients with chest pain were evaluated for ACS during the study period. Four hundred thirty-one patients were excluded for having 1 or more of the following findings: initial ECG diagnostic of injury; baseline CK-MB level, cTnI level, or both diagnostic of acute myocardial infarction; 2-hour DeltaCK-MB level of +1.5 ng/mL or greater; 2-hour DeltacTnI level of +0.2 ng/mL or greater; injury or new or evolving ischemia on serial 12-lead ECG monitoring; or clinical diagnosis of ACS. Of the 1,775 study patients, 805 (45.4%) underwent immediate dual nuclear scanning. A positive stress nuclear scan result was more sensitive (97.3% versus 71.2%, P <.0001) and specific (87.7% versus 72.6%, P <.0001) for 30-day ACS than a positive resting nuclear scan result. The protocol of selective dual nuclear scanning (ie, patients who did not undergo dual nuclear scanning were counted as having a negative test result) had a sensitivity and specificity for 30-day ACS of 93.4% and 94.7%, respectively (positive likelihood ratio 17.6; negative likelihood ratio 0.07).
CONCLUSION: Stress nuclear scanning is more sensitive and specific than resting nuclear scanning for identification of ACS in low-risk patients with chest pain. A strategy of using selective dual nuclear scanning once high- and intermediate-risk ACS has been ruled out with our 2-hour evaluation both reliably identifies and reliably excludes 30-day ACS.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app