title: Effectiveness of nuclear scan strategy in low-risk chest pain patients: novel insights from the real world.
abstract: OBJECTIVE
  The aim this study is to update the diagnostic implementation of a costly scan strategy in chest pain (CP) patients.
  
  
  METHODS
  Low-risk CP patients with a negative first-line work-up including clinical evaluation, serial ECGs, and serial troponins underwent stress myocardial perfusion imaging (MPI). Those with perfusion defects underwent angiography, whereas the remaining patients were discharged and followed up. The endpoint was coronary stenosis greater than or equal to 50% at angiography or cardiovascular death, myocardial infarction, unstable angina, and revascularization at follow-up.
  
  
  RESULTS
  Out of 1089 patients enrolled, 966 underwent exercise-MPI and 123 pharmacological-MPI (91 adenosine-MPI and 32 dipyridamole-MPI). Areas under the receiver-operating characteristic curve of exercise-MPI and pharmacological-MPI were comparable. The sensitivity and negative predictive value were significantly higher in patients subjected to exercise-MPI or pharmacological-MPI versus exercise-ECG or pharmacological-ECG (P < 0.001). The presence of basal nonischemic ECG or basal nonischemic echocardiography alterations was an independent predictor of coronary events; in these patients, the positive predictive value of the nuclear scan was significantly higher compared with the remaining patients (72 vs. 43%, P < 0.0001). The predictive values in patients subjected to adenosine-MPI or dipyridamole-MPI were eventually comparable.
  
  
  CONCLUSIONS
  In low-risk CP patients, a costly stress nuclear scan strategy added incremental prognostic value over stress-ECG and was appropriate especially in patients presenting basal nonischemic ECG or basal nonischemic echocardiography alterations.
authors.affiliation: Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy. aaaconti@hotmail.com
authors.lastname: Alberto Conti
authors.lastname: Margherita Luzzi
authors.lastname: Cristina Nanna
authors.lastname: Chiara Gallini
authors.lastname: Egidio Costanzo
authors.lastname: Luca Vaggelli
authors.lastname: Luigi Padeletti
authors.lastname: Gian Franco Gensini
mesh_terms: D000241:Adenosine; D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis; D002637:Chest Pain / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000191:economics / Q000379:methods*; D009204:Myocardial Revascularization; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine