title: Impact of Rest Myocardial Perfusion Imaging on Clinical Management of Non-High Risk Chest Pain in the VA Caribbean Healthcare System Emergency Department: 2006-2008.
abstract: OBJECTIVE
  To evaluate the appropriate clinical use of an acute rest myocardial perfusion imaging (R-MPI) in the initial emergency department (ED) evaluation of a patient presenting with chest pain (CP).
  
  
  METHODS
  This is a retrospective study of patients evaluated with CP at the ED with an acute R-MPI. The data collected included medical history, clinical presentation, electrocardiogram, laboratory data, MPI results, confirmatory studies, disposition diagnosis and cost analysis.
  
  
  RESULTS
  Three-hundred-sixty-six (366) patients were evaluated. The population studied had a mean Thrombolysis in Myocardial Infarction (TIMI) score of 2 and predominance of patients in the Virginia Commonwealth University (VCU) CP Category-Scale between level 3 and 4 (34% and 49% respectively). The risk of acute coronary syndrome (ACS) was significantly higher in patients with abnormal compared to normal studies (50% versus 0.4%; P < .0005; RR, 129.5; 95% CI, 18 to 924). There were a total of 14 and 19 major adverse cardiovascular events (MACE) events during the follow-up of 30-days and 1-year respectively. There were no cardiovascular fatalities. The risk of MACE at 30-days was significantly higher in patients with abnormal compared to normal studies (12% versus 0.4%; P < .001; RR, 32; 95% CI, 4.2 to 240), as well as with 1-year of follow-up (14% versus 1.6%; P < .001; RR, 9.1; 95% CI, 3.1 to 27).
  
  
  CONCLUSIONS
  Using acute R-MPI in the evaluation of non-high risk patients presenting with CP is a safe, reliable and cost-effective strategy to be used in the ED to predict ACS and future MACE.
authors.affiliation: Veterans Affairs Caribbean Healthcare System, San Juan PR; University of Puerto Rico, Medical Sciences Campus, San Juan, PR.
authors.forename: Irma L
authors.initials: IL
authors.lastname: Molina
authors.affiliation: Veterans Affairs Caribbean Healthcare System, San Juan PR; University of Puerto Rico, Medical Sciences Campus, San Juan, PR.
authors.forename: José
authors.initials: J
authors.lastname: Escabí-Mendoza
authors.affiliation: Veterans Affairs Caribbean Healthcare System, San Juan PR; University of Puerto Rico, Medical Sciences Campus, San Juan, PR.
authors.forename: Bartolo
authors.initials: B
authors.lastname: Santiago-Delgado
authors.affiliation: Veterans Affairs Caribbean Healthcare System, San Juan PR.
authors.forename: Jaime
authors.initials: J
authors.lastname: Aponte-Rodríguez
authors.affiliation: Veterans Affairs Caribbean Healthcare System, San Juan PR.
authors.forename: Marta J
authors.initials: MJ
authors.lastname: Turull
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011647:Puerto Rico / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D055815:Young Adult
keywords: Acute Coronary Syndrome; Acute Rest Myocardial Perfusion Imaging; Chest Pain; Coronary Artery Disease; Emergency Department