title: Resting sestamibi imaging for the prognosis of low-risk chest pain.
abstract: OBJECTIVE
  To assess the prognostic value of resting Tc-99m sestamibi scanning for adverse cardiac events (ACEs) in ED chest pain patients with a low probability of acute cardiac ischemia (ACI).
  
  
  METHODS
  Sixty-nine consenting, hemodynamically stable patients with chest pain and a nondiagnostic electrocardiogram received an injection of 25 mCi of sestamibi during or within two hours of active pain. Scans were interpreted locally by a nuclear cardiologist or radiologist. Interrater reliability was assessed. ACEs of myocardial infarction (MI), death, or revascularization were assessed during the index hospitalization and over a one-year follow-up period.
  
  
  RESULTS
  For ACEs, rest scanning with sestamibi had a sensitivity of 71% (95% CI = 0.33 to 0.97), a specificity of 92% (95% CI = 0.82 to 0.97), and an accuracy of 90% (95% CI = 0.87 to 0.99). The positive predictive value was 50% (95% CI = 0.19 to 0.82) and the negative predictive value was 97% (95% CI = 0.87 to 0.98). Sestamibi scanning was highly discriminating, with 62% of patients with positive scans but only 3% with negative scans having ACEs (p<0.001, log rank test).
  
  
  CONCLUSIONS
  In patients with low-risk chest pain, sestamibi scanning has good specificity and moderate sensitivity for ACEs over a 12-month period.
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, MI 48201, USA. jkosnik@med.wayne.edu
authors.forename: J W
authors.initials: JW
authors.lastname: Kosnik
authors.forename: R J
authors.initials: RJ
authors.lastname: Zalenski
authors.forename: F
authors.initials: F
authors.lastname: Shamsa
authors.forename: R
authors.initials: R
authors.lastname: Harris
authors.forename: J
authors.initials: J
authors.lastname: Mittner
authors.forename: J
authors.initials: J
authors.lastname: Kozlowski
authors.forename: M
authors.initials: M
authors.lastname: Di Carli
authors.forename: J E
authors.initials: JE
authors.lastname: Udelson
mesh_terms: D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging*; D009204:Myocardial Revascularization; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi