Performance of rest myocardial perfusion imaging in the management of acute chest pain in the emergency room in developing nations (PREMIER trial).
BACKGROUND
Rest myocardial perfusion imaging (MPI) is effective in managing patients with acute chest pain in developed countries. We aimed to define the role and feasibility of rest MPI in low-to-middle income countries.


RESULTS
Low-to-intermediate risk patients (n = 356) presenting with chest pain to ten centers in eight developing countries were injected with a Tc-99m-based tracer, and standard imaging was performed. The primary outcome was a composite of death, non-fatal myocardial infarction (MI), recurrent angina, and coronary revascularization at 30 days. Sixty-nine patients had a positive MPI (19.4%), and 52 patients (14.6%) had a primary outcome event. An abnormal rest-MPI result was the only variable which independently predicted the primary outcome [adjusted odds ratio (OR) 8.19, 95% confidence interval 4.10-16.40, P = .0001]. The association of MPI result and the primary outcome was stronger (adjusted OR 17.35) when only the patients injected during pain were considered. Rest-MPI had a negative predictive value of 92.7% for the primary outcome, improving to 99.3% for the hard event composite of death or MI.


CONCLUSIONS
Our study demonstrates that rest-MPI is a reliable test for ruling out MI when applied to patients in developing countries.
Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia. nathan.better@mh.org.au
Nathan
N
Better
Ganesan
G
Karthikeyan
João
J
Vitola
Arzoo
A
Fatima
Amalia
A
Peix
Maja Dolenc
MD
Novak
Jose
J
Soares
Vu Dien
VD
Bien
Pilar Orellana
PO
Briones
Mboyo
M
Vangu
Nischal
N
Soni
Anna
A
Nguyen
Maurizio
M
Dondi
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D059787:Acute Pain; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003906:Developing Countries; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012146:Rest; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi