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Performance of Rest Myocardial Perfusion Imaging in the Management of Acute Chest Pain in the Emergency Room
Closed for proposals
Project Type
Project Code
E13032CRP
1411Approved Date
Start Date
Expected End Date
Completed Date
24 February 2012Description
Myocardial perfusion imaging is an emerging technique to help triage patients presenting to the emergency room with chest pain and who present with a normal or non-diagnostic electrocardiogram. The method has been shown to demonstrate a high cost saving and decrease length of stay in hospital. In essence, a normal study allows the safe discharge of the patient from the emergency department. The purpose of our study is to extrapolate these data to the developing world and to assess the ability of this technique to predict the 30 day cardiac event rate.
Objectives
To establish effective use of appropriate in vivo nuclear medicine procedures in the management of non-communicable diseases in the developing Member States.
Specific objectives
The primary hypothesis of this CRP is that a normal myocardial perfusion SPECT study at rest, performed within the first 6 hours of admission, safely rules out an Acute Coronary Syndrome. We specifically selected patients with chest pain presenting with non diagnostic ECG and negative troponin at admission.
The secondary hypothesis is that a normal myocardial perfusion SPECT study at rest is not associated with major events within the first 30 days of clinical course.
Impact
This study was designed to evaluate patients arriving to the ER with acute chest pain in 10 centres of 8 nations (Brazil, Chile, Cuba, India, Pakistan, Slovenia, South Africa and Vietnam). We included patients who presented to the ER within 6 hours from the last episode of chest pain, with low-intermediate probability of having ACS, and a normal or non diagnostic electrocardiogram. Patients with known coronary artery disease (CAD) or a known initial positive troponin level were excluded. Results are expressed as mean ± 1SD, median or percentage of the total. Hard cardiac event rate (a composite of cardiac death, non fatal MI, admission for ACS and revascularisation not driven by follow-up stress testing) was assessed at 30 days. Currently 350 patients are included in this study, mean age 53.2 ± 12.7 years-old, 42.7% women. Mean body mass index (BMI) was 27,1 ± 4.6.There were 45 patients (12.6%) with DM, 195 (54.9%) with hypertension, 26.4% smoking, 25.8% dyslipidaemia and 27% with family history of CAD. Patients received IV 99m Tc based tracer injection (87% Sestamibi and 13% Tetrafosmin). See tables in attachment for more detailed analysis of results..
Relevance
Our study has demonstrated that a protocol to investigate low-to-intermediate probability chest pain syndromes incorporating rest MPI can be readily implemented in the developing world. The technique is safe and feasible and has an extremely high NPV, particularly in predicting death and nonfatal MI. With the problem of coronary disease growing, a call for developing nations to increase the availability of nuclear medicine facilities is timely.