title: Pretest probability assessment for selective rest sestamibi scans in stable chest pain patients.
abstract: The objective of this study was to determine whether pretest probability assessments permit more selective testing of chest pain patients with technetium-99m sestamibi scanning. Pretest probabilities of cardiac ischemia were measured both objectively (Acute Cardiac Ischemia Time-Insensitive Predictive Instrument [ACI-TIPI]) and subjectively (physician's estimate of the probability of unstable angina). Two groups were defined: patients whose postsestamibi scan led to a "downgrade" of the intensity of monitoring and those that resulted in no change in monitoring intensity. Sixty-five patients met study criteria; 25 had a disposition downgrade and 40 had no change. Pretest ACI-TIPI scores were similar in the two groups (29% +/- 18% versus 27% +/- 11%, mean +/- standard deviation; P = .95) as were the physician's assessment of unstable angina (39% +/- 22% versus 40% +/- 24%; P = .75). Objective or subjective pretest probabilities are not significantly different in patients who are likely to have their disposition altered by sestamibi scanning.
authors: Wayne State University School of Medicine, Detroit, MI, USA. rwelch@med.wayne.edu
authors: R D
authors: RD
authors: Welch
authors: R J
authors: RJ
authors: Zalenski
authors: F
authors: F
authors: Shamsa
authors: D R
authors: DR
authors: Waselewsky
authors: J W
authors: JW
authors: Kosnik
authors: S
authors: S
authors: Compton
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014218:Triage
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi