Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center

Efficacy of Multislice Computed Tomography for the Detection of Acute Coronary Syndrome in the Emergency Department

“…22 More recently, Abbott et al reported that 144 of 2,601 patients with acute chest pain (6%) had false-negative results based on serum enzymes and rest myocardial perfusion SPECT using 99m Tc-sestamibi. 23 Because rupture of vulnerable plaque and the subsequent thrombosis is the cause of ACS, 12,13 direct visualization of ruptured plaques and coronary artery obstruction or narrowing is the ultimate goal of using a diagnostic imaging modality for patients suspected of having ACS. Although the spatial resolution of currently available MSCT equipment is unsatisfactory for distinguishing ruptured plaques from non-ruptured plaques, MSCT can accurately detect coronary artery stenoses and occlusion, 6,7 as well as plaque texture, by measuring the CT density of the plaque.…”

Use of radionuclide imaging in acute coronary syndromes

“…With this protocol, we decreased the proportion of patients admitted from the ED with chest pain from 54% to 45%. Moreover, the proportion of chest pain patients admitted with a diagnosis of "rule-out MI" also decreased significantly, from 32% to 18% [10].…”

Acute chest pain of uncertain etiology, the short and long view

“…If 2-3 sets of biomarkers are normal and the patient remains clinically stable, either physical or pharmacological stress testing is performed before discharge. 13 During the initial observation period, a small percentage (3%) of patients may be hospitalized directly from the CPC, because of recurrent chest pain, ischemic ECG changes, or positive biomarkers. However, more than 97% of patients will go on to have stress testing.…”

“…Compared to the era before the opening of the CPC, the number of inappropriate hospitalizations decreased by 40%. 13 …”