Pretest probability assessment for selective rest sestamibi scans in stable chest pain patients.
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.
Welch
R D
RD
Wayne State University School of Medicine, Detroit, MI, USA. rwelch@med.wayne.edu
Zalenski
R J
RJ
Shamsa
F
F
Waselewsky
D R
DR
Kosnik
J W
JW
Compton
S
S
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
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi