title: Usefulness of two-dimensional echocardiography and myocardial perfusion imaging for immediate evaluation of chest pain in the emergency department.
abstract: BACKGROUND
  Accurate identification of patients in the emergency department at high risk of acute coronary syndrome with possible myocardial ischaemia and a nonischaemic electrocardiogram is problematic. Both two-dimensional echocardiography and myocardial perfusion imaging with technetium-99m-sestamibi can identify patients at low and high risk, however comparative studies are lacking.
  
  
  RESULTS
  We studied 655 consecutively patients considered at low or moderate risk for myocardial ischaemia in our Emergency Department (ED). On the basis of the presenting history, physical examination, and electrocardiogram they underwent both echocardiography and myocardial perfusion imaging within 4 h of ED presentation. End points included myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA) and positive stress perfusion imaging. Both imaging procedures were performed in the ED on 470 patients. Overall agreement between the two techniques was high (concordance 90%) in the patients who had myocardial infarction or underwent coronary angiography.
  
  
  CONCLUSIONS
  Agreement between the two imaging techniques is high when used in patients with possible myocardial ischaemia. Both techniques identified patients at high risk who required admission and those who could be safely discharged directly from the ED.
authors.affiliation: Emergency Department, University La Sapienza, via le del Policlinico 155, Rome, Italy. paventi@iol.it
authors.forename: S
authors.initials: S
authors.lastname: Paventi
authors.forename: M A
authors.initials: MA
authors.lastname: Parafati
authors.forename: E D
authors.initials: ED
authors.lastname: Luzio
authors.forename: C A
authors.initials: CA
authors.lastname: Pellegrino
mesh_terms: D002637:Chest Pain / Q000000981:diagnostic imaging*; D004452:Echocardiography; D004636:Emergency Service, Hospital; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi