title: [Early myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department].
abstract: OBJECTIVE
  To analyze the value of early resting myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department.
  
  
  METHODS
  222 patients (49% women, mean age 61 [13] years) with atypical chest pain and with non-diagnostic ECG were randomized into two groups. Group A comprised 111 patients in whom early resting myocardial perfusion gated-SPECT (<6 hours since the end of chest pain) was performed and CK-MB mass and troponin I were determined at 0, 4 and 8 hours. Group B comprised 111 patients with conventional management in the emergency department without gated-SPECT.
  
  
  RESULTS
  Myocardial perfusion gated-SPECT was positive in all 8 patients with increased levels of CK-MB mass and troponin I. This corresponded to a sensitivity and a negative predictive value of 100% for the diagnosis of AMI. Specificity was 84% and positive predictive value was 33% when doubtful results were considered as negative. The number of patients admitted (18.4% vs 32.7%, P<.027) and length of stay (13 [6] hours vs 15.9 [8.6] hours, P<.009) in the emergency department were lower in group A.
  
  
  CONCLUSIONS
  In patients with atypical chest pain and non-diagnostic ECG in the emergency department, early resting gated-SPECT was highly sensitive and showed good negative predictive value for the diagnosis of AMI, but positive predictive value was low. This technique may reduce the number of hospitalized patients and length of stay in the emergency department.
authors.affiliation: Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain. jcandell@vhebron.es
authors.forename: Jaume
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: Guillermo
authors.initials: G
authors.lastname: Oller-Martínez
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Pereztol-Valdés
authors.forename: Joan
authors.initials: J
authors.lastname: Castell-Conesa
authors.forename: Santiago
authors.initials: S
authors.lastname: Aguadé-Bruix
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Alonso
authors.forename: Rosa
authors.initials: R
authors.lastname: Segura
authors.forename: Joaquim
authors.initials: J
authors.lastname: Murillo
authors.forename: Rosina
authors.initials: R
authors.lastname: Moreno
authors.forename: Jordi
authors.initials: J
authors.lastname: Suriñach
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000628:therapy; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test / Q000379:methods*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*