Comparison of acute rest myocardial perfusion imaging and serum markers of myocardial injury in patients with chest pain syndromes.
BACKGROUND
Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes.


METHODS
Serum markers and acute technetium-99m sestamibi/tetrofosmin rest MPI were obtained in 75 patients admitted to the ED with chest pain and nondiagnostic electrocardiograms. Venous samples were drawn at admission and 8 to 24 hours later for total creatine kinase, CK-MB fraction, troponin T, troponin I, and myoglobin. Three nuclear cardiologists performed blinded image interpretation. Coronary artery disease (CAD) was confirmed either by diagnostic testing or by the occurrence of myocardial infarction (MI).


RESULTS
Acute rest MPI results were abnormal in all 9 patients with MI. An additional 26 patients had objective evidence of CAD confirmed by diagnostic testing. The sensitivity of acute rest MPI for objective evidence of CAD was 73%. Serum troponin T and troponin I were highly specific for acute MI but had low sensitivity at presentation. Individual serum markers had very low sensitivity for symptomatic myocardial ischemia alone. In the multivariate regression model, only acute rest MPI and diabetes were independently predictive of CAD.


CONCLUSIONS
At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers.
Duca
M D
MD
Department of Medicine, University of Connecticut School of Medicine, Farmington 06102, USA.
Giri
S
S
Wu
A H
AH
Morris
R S
RS
Cyr
G M
GM
Ahlberg
A
A
White
M
M
Waters
D D
DD
Heller
G V
GV
D015415:Biomarkers / Q000097:blood*; D002637:Chest Pain / Q000097:blood / Q000000981:diagnostic imaging*; D003327:Coronary Disease / Q000000981:diagnostic imaging; D003402:Creatine Kinase / Q000097:blood; D048909:Diabetes Complications; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000097:blood / Q000000981:diagnostic imaging*; D009211:Myoglobin / Q000097:blood; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D012146:Rest; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D019210:Troponin I; D020107:Troponin T; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi; D003402:Creatine Kinase