title: Negative predictive value and potential cost savings of acute nuclear myocardial perfusion imaging in low risk patients with suspected acute coronary syndrome: a prospective single blinded study.
abstract: BACKGROUND
  Previous studies from the USA have shown that acute nuclear myocardial perfusion imaging (MPI) in low risk emergency department (ED) patients with suspected acute coronary syndrome (ACS) can be of clinical value. The aim of this study was to evaluate the utility and hospital economics of acute MPI in Swedish ED patients with suspected ACS.
  
  
  METHODS
  We included 40 patients (mean age 55 +/- 2 years, 50% women) who were admitted from the ED at Lund University Hospital for chest pain suspicious of ACS, and who had a normal or non-ischemic ECG and no previous myocardial infarction. All patients underwent MPI from the ED, and the results were analyzed only after patient discharge. The current diagnostic practice of admitting the included patients for observation and further evaluation was compared to a theoretical "MPI strategy", where patients with a normal MPI test would have been discharged home from the ED.
  
  
  RESULTS
  Twenty-seven patients had normal MPI results, and none of them had ACS. MPI thus had a negative predictive value for ACS of 100%. With the MPI strategy, 2/3 of the patients would thus have been discharged from the ED, resulting in a reduction of total hospital cost by some 270 EUR and of bed occupancy by 0.8 days per investigated patient.
  
  
  CONCLUSIONS
  Our findings in a Swedish ED support the results of larger American trials that acute MPI has the potential to safely reduce the number of admissions and decrease overall costs for low-risk ED patients with suspected ACS.
authors: Divisions of Emergency Medicine, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden. jakob@lundager.eu
authors: Jakob L
authors: JL
authors: Forberg
authors: Catarina E
authors: CE
authors: Hilmersson
authors: Marcus
authors: M
authors: Carlsson
authors: Håkan
authors: H
authors: Arheden
authors: Jonas
authors: J
authors: Björk
authors: Krister
authors: K
authors: Hjalte
authors: Ulf
authors: U
authors: Ekelund
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D004469:Economics, Hospital; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016037:Single-Blind Method; D013548:Sweden
chemical_list: D019275:Radiopharmaceuticals