Robert Eisner. 2. ,. Steven Sigman. 2 and Randolph Patterson. 2. 1. Emergency Medicine;. 2. Medicine [Cardiology], Emory University School of Medicine, ...
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J Nucl Med. 2007; 48 (Supplement 2):231P This Article
Cardiovascular: Clinical Science Clinical Science Posters
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Chest pain evaluation in the emergency department: A new application for positron emission tomographic [PET] Rb-83 myocardial perfusion imaging
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Brooks Moore1, Stephen Pitts1, Comilla Sasson1, Robert Eisner2, Steven Sigman2 and Randolph Patterson2
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1 Emergency Medicine; 2 Medicine [Cardiology], Emory University School of Medicine, Atlanta, Georgia
1093 Objectives: PET myocardial Rb-82 has advantages compared to SPECT to identify coronary disease [CAD, >50% stenosis] on coronary arteriography, due to its spatial and temporal resolutions and reliable attenuation correction, however, its ability to identify CAD or acute coronary syndrome [ACS] in Emergency Department [ED] patients with chest pain is not known. Thus, we evaluated the accuracy of dipyridamole-induced defects on myocardial PET Rb-82 to predict CAD or ACS in ED chest pain patients after initial screening for acute myocardial infarction [MI]. Methods: In a retrospective cross-sectional review of medical records, we matched ED chest pain visits to a database of all PET scans for 24 months [1/1/2004 and 12/31/2005]. The PET scan was ordered by the ED physician if the observation unit workup was negative for acute MI, including serial cardiac biomarkers and ECGs. ACS was defined as positive cardiac markers, or a discharge diagnosis of ACS within 30 days of the initial ED visit. For this study we analyzed only ED chest pain patients with a positive PET Rb-82. Results: 7,691 ED visits were for chest pain. Among these patients 1177 had PET, and 1123 [95.4%] were normal or probably normal, while only 54 (4.6%) of these patients had abnormal or probably abnormal PET. Of these abnormal PETs, 28 had coronary disease [CAD, >50% stenosis] at coronary arteriography, and 4 had no CAD>50% on arteriography. Another 22 patients had ACS by clinical assessment but did not undergo angiography. Thus, the predictive value of a positive PET was 87% [95% CI = 77.8 to 97.1%], compared to coronary arteriography, and 92.5%, (95% CI = 82.1% to 97.9%), if a discharge diagnosis of ACS was included as an endpoint. Conclusions: Positive PET Rb-82 predicted CAD and ACS in ED patients with low risk chest pain, with a higher positive predictive value than historical estimates for traditional stress-SPECT myocardial perfusion imaging. PET Rb-82 myocardial perfusion imaging is attractive as an alternative to traditional provocative testing in the ED observation.
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