Author + information
- Received April 29, 1993
- Revision received November 22, 1993
- Accepted December 1, 1993
- Published online April 1, 1994.
- Thomas C. Hilton, MD, FACC∗,
- Randall C. Thompson, MD, FACC,
- Hugh J. Williams, MD,
- Robert Saylors, DO,
- Holly Fulmer, RN and
- Stephen A. Stowers, MD, FACC
- ↵∗Address for correspondence: Dr. Thomas C. Hilton, 4205 Belfort Road, Suite 2065, Jacksonville, Florida 32216.
Objectives. The purpose of this investigation was to evaluate the practicality and short-term predictive value of acute myocardial perfusion imaging with technetium-99m sestamibi in emergency room patients with typical angina and a normal or nondiagnostic electrocardiogram (ECG).
Background. Accuracy of emergency room chest pain assessment may be improved when clinical and ECG variables are used in conjunction with acute thallium-201 myocardial perfusion imaging. Technetium-99m sestamibi is a new radioisotope that is taken up by the myocardium in proportion to blood flow, but unlike thallium-201, it redistributes minimally after Injection. Technetium-99m sestamibi can thus be injected during chest pain, and images acquired 1 to 2 h later (when patients have been clinically stabilized) will confirm whether abnormalities of perfusion were present at the time of injection.
Methods. One hundred two emergency room patients with typical angina (on the basis of a standardized angina questionnaire) and a normal or nondiagnostic ECG had a technetium-99m sestamibi injection during symptoms and were followed up for occurrence of adverse cardiac events (cardiac death, nonfatal myocardial infarction, coronary angioplasty, coronary surgery or coronary thrombolysis).
Results. Univariate predictors of cardiac events included the presence of three or more coronary risk factors (p = 0.009, risk ratio 3.3) and an abnormal or equivocal acute technetium-99m sestamibi scan (p = 0.0001, risk ratio 13.9). Multivariate regression analysis identified an abnormal perfusion image as the only independent predictor of adverse cardiac events (p = 0.009). Of 70 patients with a normal perfusion scan, only 1 had a cardiac event compared with 15 patients with equivocal scans or 17 patients with abnormal scans, with a cardiac event rate of 13% and 71%, respectively (p = 0.0004).
Conclusions. Initial myocardial perfusion imaging with technetium-99m sestamibi when applied in emergency room patients with typical angina and a normal or nondiagnostic ECG appears to be highly accurate to distinguishing between low and high risk subjects.
☆ This study was supported in part by grants from Du Pont Merck Pharmaceutical Company. North Billerica, Massachusetts and Syncor Radiopharmaceutical Company, Chatsworth, California.
- Received April 29, 1993.
- Revision received November 22, 1993.
- Accepted December 1, 1993.