Effectiveness of nuclear scan strategy in low-risk chest pain patients

Conti, Alberto; Luzzi, Margherita; Nanna, Cristina; Gallini, Chiara; Costanzo, Egidio Natalino; Vaggelli, Luca; Padeletti, Luigi; Gensini, Gian Franco

doi:10.1097/mnm.0b013e32834a7182

Cited by 4 publications

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“…[11,14] Adenosine and dipyridamole are the most widely available pharmacologic agents used in stress testing in patients unable to perform the standard exercise stress test. [15,16] They dilate coronary vessels, and cause increased blood velocity and flow rate in normal vessels; conversely, the response in stenotic vessels is poor. This difference in response leads to a steal of flow, and perfusion defects appear in cardiac nuclear scans or as ST-segment changes in ECG.…”

Section: Nuclear Scan Strategy and Outcomes In Chest Pain Patients Va...mentioning

confidence: 99%

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Nuclear Scan Strategy and Outcomes in Chest Pain Patients Value of Stress Testing with Dipyridamole or Adenosine

et al. 2014

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Objective:To update the prognostic value of scan strategy with pharmacological stress agent in chest pain (CP) patients presenting with normal electrocardiography (ECG) and troponin.Methods:Two consecutive nonrandomized series of patients with CP and negative first-line workup inclusive of serial ECG, serial troponin, and echocardiography underwent myocardial perfusion imaging single photon emission computed tomography (SPECT) in the emergency department. Of 170 patients enrolled, 52 patients underwent dipyridamole-SPECT and 118 adenosine-SPECT. Patients with perfusion defects underwent angiography, whereas the remaining patients were discharged and followed-up. Primary endpoint was the composite of nonfatal myocardial infarction, unstable angina, revascularization, and cardiovascular death at follow-up or the presence of coronary stenosis > 50% at angiography.Results:At multivariate analysis, the presence of perfusion defects or hypertension was independent predictor of the primary endpoint. Sensitivity and negative predictive value were higher in patients subjected to adenosine-SPECT (95% and 99%, respectively) versus dipyridamole-SPECT (56% and 89%; yield 70% and 11%, respectively; P < 0.03). Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively).Conclusions:In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT. Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.

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Section: Nuclear Scan Strategy and Outcomes In Chest Pain Patients Va...mentioning

confidence: 99%

“…[1516] They dilate coronary vessels, and cause increased blood velocity and flow rate in normal vessels; conversely, the response in stenotic vessels is poor. This difference in response leads to a steal of flow, and perfusion defects appear in cardiac nuclear scans or as ST-segment changes in ECG.…”

Section: Introductionmentioning

confidence: 99%

Nuclear Scan Strategy and Outcomes in Chest Pain Patients Value of Stress Testing with Dipyridamole or Adenosine

et al. 2014

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“…The ROMICAT II study compared CTCA with standard care (various) with the same finding. Conti et al . compared exercise ECG and exercise MPI in ED chest pain patients without known CAD.…”

Section: Comparison With Alternative Investigation Strategies and Cosmentioning

confidence: 99%

“…The ROMICAT II study 3 compared CTCA with standard care (various) with the same finding. Conti et al 9 compared exercise ECG and exercise MPI in ED chest pain patients without known CAD. They reported that MPI had a sensitivity of 87% with NPV for MACE of 97.2% as compared with exercise ECG sensitivity of 19.5% and NPV 86%.…”

Section: Comparison With Alternative Investigation Strategies and Cosmentioning

confidence: 99%

Computed tomography coronary angiography: Is it such a useful test for emergency department chest pain patients?

Kelly

2013

Emerg Medicine Australasia

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Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies

Romero¹,

Husain²,

Holmes³

et al. 2015

International Journal of Cardiology

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Effectiveness of nuclear scan strategy in low-risk chest pain patients

Abstract: 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.

Cited by 4 publications

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Nuclear Scan Strategy and Outcomes in Chest Pain Patients Value of Stress Testing with Dipyridamole or Adenosine

Nuclear Scan Strategy and Outcomes in Chest Pain Patients Value of Stress Testing with Dipyridamole or Adenosine

Computed tomography coronary angiography: Is it such a useful test for emergency department chest pain patients?

Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies

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