Acute resting myocardial perfusion imaging in patients with diabetes mellitus: results from the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial.
BACKGROUND
Resting myocardial perfusion imaging (MPI) improves the triage of patients presenting to the emergency department (ED) with symptoms suggestive of acute cardiac ischemia (ACI). In the ED setting the presence of diabetes mellitus (DM) is a predictor of ACI and hospitalization, but the role of resting MPI in patients with DM is unknown.


RESULTS
A secondary data analysis of a prospective, multicenter, randomized, controlled trial of ED evaluation strategies in patients with symptoms suggestive of ACI and normal or nondiagnostic electrocardiograms was performed. In the main trial 2475 patients were randomized to receive either the usual ED evaluation strategy (n = 1260) or the usual strategy supplemented by results from resting MPI by use of single photon emission computed tomography (SPECT) technetium 99m sestamibi (n = 1215). Patients with diabetes (n = 341) were evaluated separately. Imaging results, final diagnoses, effect on triage, and prognostic value of the SPECT imaging were compared between diabetic and nondiabetic patients. Of the 341 patients with diabetes, 153 (45%) were randomized to the imaging strategy. Patients with DM had higher rates of hospitalization (66% vs 49.6%, P = .0001) and ACI (21.1% vs 12.0%, P < .001) than patients without DM. Among diabetic patients without ACI, the admission rate was 63% in the usual strategy group versus 54% in the imaging strategy group (relative risk [RR] = 0.91 [95% CI, 0.76-1.06]; P = .24). There was no difference in the magnitude of this reduced risk of admission compared with patients without DM (RR = 0.84 [95% CI, 0.77-0.92]; P = .0002 for patients without DM and P = .35 for interaction of diabetes and RR reduction).


CONCLUSIONS
Acute resting MPI with Tc-99m sestamibi is associated with improved triage decision making in symptomatic ED patients with diabetes.
Hnry Low Heart Center for the Division of Cardiology, Hartford Hospital, Hartford, CT 06102, USA.
Athanasios
A
Kapetanopoulos
Gary V
GV
Heller
Harry P
HP
Selker
Robin
R
Ruthazer
Joni R
JR
Beshansky
James A
JA
Feldman
John L
JL
Griffith
Robert C
RC
Hendel
J Hector
JH
Pope
Ethan J
EJ
Spiegler
James E
JE
Udelson
D000208:Acute Disease; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012146:Rest; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi