title: Gated-SPECT myocardial perfusion imaging and coronary calcium score for evaluation of patients with acute chest pain and a normal or nondiagnostic electrocardiogram.
abstract: OBJECTIVE
  To assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute coronary syndrome (ACS) in emergency department patients, as well as to investigate whether there exists a concordance between MPI and coronary calcium.
  
  
  METHODS
  Fifty-five patients with chest pain and a normal or nondiagnostic ECG were included. Clinical follow-up was carried out within 1 year.
  
  
  RESULTS
  Sixteen patients (29%) showed an abnormal rest MPI, and in 11 (20%) the MPI was equivocal. There was a weak concordance between MPI and coronary arteries calcium score (CACS) (κ: 0.25). Coronary angiogram driven by a positive MPI was performed in 12 patients (23%), resulting in percutaneous coronary intervention in nine cases (75%). A positive MPI (abnormal or equivocal results) was associated with the occurrence of events in the follow-up (χ(2)=19.961, P<0.0001). For a patient presenting to the emergency department with acute chest pain and a normal or nondiagnostic ECG, with a positive MPI, the relative risk of having events during the first year was 7.5 (95% confidence interval: 2.8-19.2), P<0.05, but with a positive CACS this was 1.77 (95% confidence interval: 0.69-4.56), P=NS. At 1 year 68.6% of patients were free of events.
  
  
  CONCLUSIONS
  Patients presenting with acute chest pain and a low-to-intermediate likelihood of coronary artery disease with a normal rest MPI have a very low probability of cardiac events during the first year. Coronary calcium score was not helpful in risk-stratifying these patients.
authors.affiliation: Departments of Nuclear Medicine, Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu
authors.forename: Amalia
authors.initials: A
authors.lastname: Peix
authors.forename: Elida
authors.initials: E
authors.lastname: Batista
authors.forename: Lázaro O
authors.initials: LO
authors.lastname: Cabrera
authors.forename: Lydia
authors.initials: L
authors.lastname: Rodríguez
authors.forename: Kenia
authors.initials: K
authors.lastname: Padrón
authors.forename: Benito
authors.initials: B
authors.lastname: Saínz
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mendoza
authors.forename: Regla
authors.initials: R
authors.lastname: Carrillo
authors.forename: Yoel
authors.initials: Y
authors.lastname: Fernández
authors.forename: Erick
authors.initials: E
authors.lastname: Mena
authors.forename: Maurizio
authors.initials: M
authors.lastname: Dondi
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061205:Vascular Calcification / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging