title: Myocardial perfusion scintigraphy (SPECT) in the evaluation of patients in the emergency room with precordial pain and normal or doubtful ischemic ECG. Study 60 cases.
abstract: OBJECTIVE
  To evaluate the diagnostic utility of myocardial perfusion by SPECT and Gated-SPECT in the diagnosis of acute coronary syndrome in patients with precordial pain associated with normal or doubtful ischemic ECG within the first 6 hrs of the last episode of pain.
  
  
  METHODS
  Sixty such patients who sought attention in the Emergency room were included. Myocardial perfusion SPECT and Gated-SPECT (GSPECT) was performed in all patients using two distinct protocols. All patients underwent resting and pharmacological stress test. In 30 cases coronary angiogram were performed.
  
  
  RESULTS
  Resting myocardial perfusion was abnormal or positive in 25 patients (42%) and normal or negative in 35 patients (58%). In the latter group perfusion became abnormal in 15 patients (43%) under stress with dipyridamole, while it remained normal in 19 (54%). The last subgroup presented no coronary events during the 12 months following their hospital discharge. In the group of 25 patients with resting perfusion abnormalities acute myocardial infarction was diagnosed in 7 patients, ischemia in 12 and reverse-reversibility in 6. Myocardial perfusion scintigraphy showed in the resting phase a low sensitivity of 61% (95% CI 39-74%), and negative predictive value of 71% (95% CI, 58-82%). During the stress phase, the utility of the test increased significantly, with a sensitivity of 97% (95% CI, 83-99%), specificity of 79% (95% CI, 57-92%), positive predictive value of 87% (95% CI, 72-95%) and, most outstanding, a negative predictive value of 95% CI, 73-99%).
  
  
  CONCLUSIONS
  Myocardial perfusion studies have a sensitivity of 97% for identifying patients with acute coronary syndrome, with precordial pain and normal or doubtful ischemic ECG. For the intermediate or low risk patients with acute coronary syndrome the non-invasive diagnostic techniques of SPECT and GSPECT systems of evaluating myocardial perfusion achieve a high degree diagnostic accuracy, safety and reduces unnecessary admissions and costs.
authors.affiliation: Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, México, D.F.
authors.forename: D
authors.initials: D
authors.lastname: Bialostozky
authors.forename: M
authors.initials: M
authors.lastname: López-Meneses
authors.forename: L
authors.initials: L
authors.lastname: Crespo
authors.forename: A
authors.initials: A
authors.lastname: Puente-Barragán
authors.forename: H
authors.initials: H
authors.lastname: González-Pacheco
authors.forename: E
authors.initials: E
authors.lastname: Lupi-Herrera
authors.forename: D
authors.initials: D
authors.lastname: Victoria
authors.forename: J
authors.initials: J
authors.lastname: Altamirano
authors.forename: I
authors.initials: I
authors.lastname: Martínez
authors.forename: C
authors.initials: C
authors.lastname: Keirns
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D002985:Clinical Protocols; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging*; D010477:Perfusion; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods