Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center
Emergency department chest pain centers (CPCs) vary in their approach to patients with chest pain and nonischemic electrocardiograms (ECG). Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stre...
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| Veröffentlicht in: | The American journal of cardiology 2001-06, Vol.87 (12), p.1351-1355 |
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| creator | Abbott, Brian G Abdel-Aziz, Islam Nagula, Satish Monico, Edward P Schriver, John A Wackers, Frans J.Th |
| description | Emergency department chest pain centers (CPCs) vary in their approach to patients with chest pain and nonischemic electrocardiograms (ECG). Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stress, we questioned its application in all patients. We prospectively evaluated the utility of selective SPECT imaging in a CPC (i.e., rest SPECT for ongoing pain, stress SPECT if unable to undergo exercise electrocardiography) and its impact on the overall disposition of all emergency department chest pain patients. Over 3 years, 2,601 patients were evaluated in a CPC (2,211 [85%] were sent home, 390 [15%] were hospitalized). Of 390 CPC patients hospitalized, 182 (47%) were diagnosed with coronary artery disease at the time of hospital discharge. Only 28 patients (1.1%) had an acute myocardial infarction. After 3 years, the proportion of all chest pain patients hospitalized and those diagnosed as “rule-out myocardial infarction” decreased from 53% to 41% and 32% to 18% of all chest pain patients, respectively (both p |
| doi_str_mv | 10.1016/S0002-9149(01)01551-X |
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Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stress, we questioned its application in all patients. We prospectively evaluated the utility of selective SPECT imaging in a CPC (i.e., rest SPECT for ongoing pain, stress SPECT if unable to undergo exercise electrocardiography) and its impact on the overall disposition of all emergency department chest pain patients. Over 3 years, 2,601 patients were evaluated in a CPC (2,211 [85%] were sent home, 390 [15%] were hospitalized). Of 390 CPC patients hospitalized, 182 (47%) were diagnosed with coronary artery disease at the time of hospital discharge. Only 28 patients (1.1%) had an acute myocardial infarction. After 3 years, the proportion of all chest pain patients hospitalized and those diagnosed as “rule-out myocardial infarction” decreased from 53% to 41% and 32% to 18% of all chest pain patients, respectively (both p <0.0001). Overall, 906 patients (35%) required SPECT imaging to complete the CPC evaluation. Had SPECT imaging not been performed selectively, and all 906 patients been admitted, 762 (29%) would have been hospitalized unnecessarily based on the final diagnoses. Alternatively, sending all these patients home would have resulted in 144 (6%) inappropriate discharges of patients with coronary artery disease. A CPC protocol using the selective use of SPECT imaging permits the complete evaluation of all patients in the CPC, significantly reduces hospitalizations for chest pain, and restricts hospital admission to more appropriate patients.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/S0002-9149(01)01551-X</identifier><identifier>PMID: 11397352</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Angina Pectoris - diagnostic imaging ; Angina Pectoris - physiopathology ; Biological and medical sciences ; Cardiology ; Cardiovascular disease ; Cardiovascular system ; Chest Pain - diagnostic imaging ; Chest Pain - etiology ; Chest Pain - physiopathology ; Clinical Protocols ; Coronary Circulation - physiology ; Coronary Disease - diagnostic imaging ; Coronary Disease - physiopathology ; Coronary vessels ; Diagnosis, Differential ; Electrocardiography ; Emergency Service, Hospital ; Exercise Test ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - diagnostic imaging ; Myocardial Infarction - physiopathology ; Pain ; Patient Admission ; Radionuclide investigations ; Tomography ; Tomography, Emission-Computed, Single-Photon ; Triage</subject><ispartof>The American journal of cardiology, 2001-06, Vol.87 (12), p.1351-1355</ispartof><rights>2001 Excerpta Medica Inc.</rights><rights>2001 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. 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Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stress, we questioned its application in all patients. We prospectively evaluated the utility of selective SPECT imaging in a CPC (i.e., rest SPECT for ongoing pain, stress SPECT if unable to undergo exercise electrocardiography) and its impact on the overall disposition of all emergency department chest pain patients. Over 3 years, 2,601 patients were evaluated in a CPC (2,211 [85%] were sent home, 390 [15%] were hospitalized). Of 390 CPC patients hospitalized, 182 (47%) were diagnosed with coronary artery disease at the time of hospital discharge. Only 28 patients (1.1%) had an acute myocardial infarction. After 3 years, the proportion of all chest pain patients hospitalized and those diagnosed as “rule-out myocardial infarction” decreased from 53% to 41% and 32% to 18% of all chest pain patients, respectively (both p <0.0001). Overall, 906 patients (35%) required SPECT imaging to complete the CPC evaluation. Had SPECT imaging not been performed selectively, and all 906 patients been admitted, 762 (29%) would have been hospitalized unnecessarily based on the final diagnoses. Alternatively, sending all these patients home would have resulted in 144 (6%) inappropriate discharges of patients with coronary artery disease. A CPC protocol using the selective use of SPECT imaging permits the complete evaluation of all patients in the CPC, significantly reduces hospitalizations for chest pain, and restricts hospital admission to more appropriate patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Angina Pectoris - diagnostic imaging</subject><subject>Angina Pectoris - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular system</subject><subject>Chest Pain - diagnostic imaging</subject><subject>Chest Pain - etiology</subject><subject>Chest Pain - physiopathology</subject><subject>Clinical Protocols</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary vessels</subject><subject>Diagnosis, Differential</subject><subject>Electrocardiography</subject><subject>Emergency Service, Hospital</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Pain</subject><subject>Patient Admission</subject><subject>Radionuclide investigations</subject><subject>Tomography</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><subject>Triage</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9r3DAQxUVpaLZpP0KLKKW0B7czli1Lp1BC_wQCPSSH3IRWHu8q2JYr2YH99lF2l7b0kpM08HuPmfcYe4PwGQHll2sAKAuNlf4I-AmwrrG4fcZWqBpdoEbxnK3-IKfsZUp3eUSs5Qt2iih0I-pyxcI19eRmf098ScRDx5MfNz0V0zbMYeQ0-JR8_rgwTMtMLZ_DEDbRTtsdH3bB2dh62_OJYrfsQT_YTbbgfuSWuy2lmU82D47GmeIrdtLZPtHr43vGbr5_u7n4WVz9-nF58fWqcEKruZCqqklK6dYNka4AXGVRybIrER2RUhLXUoIGawGptK6WzVqpVjhNAqw4Yx8OtlMMv5e8g8l3OOp7O1JYkmmytGkkZPDdf-BdWOKYVzOlACGxqlSG6gPkYkgpUmemmM-MO4NgHtsw-zbMY9QG0OzbMLdZ9_ZovqwHav-qjvFn4P0RsMnZvot2dD794545kBk7P2CUE7v3FE1ynkZHrY-5PNMG_8QmDzSwp04</recordid><startdate>20010615</startdate><enddate>20010615</enddate><creator>Abbott, Brian G</creator><creator>Abdel-Aziz, Islam</creator><creator>Nagula, Satish</creator><creator>Monico, Edward P</creator><creator>Schriver, John A</creator><creator>Wackers, Frans J.Th</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20010615</creationdate><title>Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center</title><author>Abbott, Brian G ; Abdel-Aziz, Islam ; Nagula, Satish ; Monico, Edward P ; Schriver, John A ; Wackers, Frans J.Th</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-6845e666cb7ee9400c4a1862f211cee8861b66090aa01e2ac567b88d3c9e30a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Angina Pectoris - diagnostic imaging</topic><topic>Angina Pectoris - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular system</topic><topic>Chest Pain - diagnostic imaging</topic><topic>Chest Pain - etiology</topic><topic>Chest Pain - physiopathology</topic><topic>Clinical Protocols</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary vessels</topic><topic>Diagnosis, Differential</topic><topic>Electrocardiography</topic><topic>Emergency Service, Hospital</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Pain</topic><topic>Patient Admission</topic><topic>Radionuclide investigations</topic><topic>Tomography</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><topic>Triage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abbott, Brian G</creatorcontrib><creatorcontrib>Abdel-Aziz, Islam</creatorcontrib><creatorcontrib>Nagula, Satish</creatorcontrib><creatorcontrib>Monico, Edward P</creatorcontrib><creatorcontrib>Schriver, John A</creatorcontrib><creatorcontrib>Wackers, Frans J.Th</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abbott, Brian G</au><au>Abdel-Aziz, Islam</au><au>Nagula, Satish</au><au>Monico, Edward P</au><au>Schriver, John A</au><au>Wackers, Frans J.Th</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2001-06-15</date><risdate>2001</risdate><volume>87</volume><issue>12</issue><spage>1351</spage><epage>1355</epage><pages>1351-1355</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Emergency department chest pain centers (CPCs) vary in their approach to patients with chest pain and nonischemic electrocardiograms (ECG). Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stress, we questioned its application in all patients. We prospectively evaluated the utility of selective SPECT imaging in a CPC (i.e., rest SPECT for ongoing pain, stress SPECT if unable to undergo exercise electrocardiography) and its impact on the overall disposition of all emergency department chest pain patients. Over 3 years, 2,601 patients were evaluated in a CPC (2,211 [85%] were sent home, 390 [15%] were hospitalized). Of 390 CPC patients hospitalized, 182 (47%) were diagnosed with coronary artery disease at the time of hospital discharge. Only 28 patients (1.1%) had an acute myocardial infarction. After 3 years, the proportion of all chest pain patients hospitalized and those diagnosed as “rule-out myocardial infarction” decreased from 53% to 41% and 32% to 18% of all chest pain patients, respectively (both p <0.0001). Overall, 906 patients (35%) required SPECT imaging to complete the CPC evaluation. Had SPECT imaging not been performed selectively, and all 906 patients been admitted, 762 (29%) would have been hospitalized unnecessarily based on the final diagnoses. Alternatively, sending all these patients home would have resulted in 144 (6%) inappropriate discharges of patients with coronary artery disease. A CPC protocol using the selective use of SPECT imaging permits the complete evaluation of all patients in the CPC, significantly reduces hospitalizations for chest pain, and restricts hospital admission to more appropriate patients.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>11397352</pmid><doi>10.1016/S0002-9149(01)01551-X</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Aged Angina Pectoris - diagnostic imaging Angina Pectoris - physiopathology Biological and medical sciences Cardiology Cardiovascular disease Cardiovascular system Chest Pain - diagnostic imaging Chest Pain - etiology Chest Pain - physiopathology Clinical Protocols Coronary Circulation - physiology Coronary Disease - diagnostic imaging Coronary Disease - physiopathology Coronary vessels Diagnosis, Differential Electrocardiography Emergency Service, Hospital Exercise Test Female Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Myocardial Infarction - diagnostic imaging Myocardial Infarction - physiopathology Pain Patient Admission Radionuclide investigations Tomography Tomography, Emission-Computed, Single-Photon Triage |
| title | Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center |
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