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Resting Sestamibi Imaging for the Prognosis of Low‐risk Chest Pain
Author(s) -
Kosnik Joseph W.,
Zalenski Robert J.,
Shamsa Falah,
Harris Richard,
Mittner Jay,
Kozlowski Jay,
Di Carli Marcelo,
Udelson James E.
Publication year - 1999
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1999.tb01182.x
Subject(s) - medicine , chest pain , myocardial infarction , cardiology , technetium tc 99m sestamibi , revascularization , technetium (99mtc) sestamibi , radiology , nuclear medicine , scintigraphy
. Objective: To assess the prognostic value of resting Tc‐99m sestamibi scanning for adverse cardiac events (ACEs) in ED chest pain patients with a low probability of acute cardiac ischemia (ACI). Methods: Sixty‐nine consenting, hemodynamically stable patients with chest pain and a nondiagnostic electrocardiogram received an injection of 25 mCi of sestamibi during or within two hours of active pain. Scans were interpreted locally by a nuclear cardiologist or radiologist. Interrater reliability was assessed. ACEs of myocardial infarction (MI), death, or revascularization were assessed during the index hospitalization and over a one‐year follow‐up period. Results: For ACEs, rest scanning with sestamibi had a sensitivity of 71% (95% CI = 0.33 to 0.97), a specificity of 92% (95% CI = 0.82 to 0.97), and an accuracy of 90% (95% CI = 0.87 to 0.99). The positive predictive value was 50% (95% CI = 0.19 to 0.82) and the negative predictive value was 97% (95% CI = 0.87 to 0.98). Sestamibi scanning was highly discriminating, with 62% of patients with positive scans but only 3% with negative scans having ACEs (p < 0.001, log rank test). Conclusion: In patients with low‐risk chest pain, sestamibi scanning has good specificity and moderate sensitivity for ACEs over a 12‐month period.