Yield of Early Rest and Stress Myocardial Perfusion Single-Photon Emission Computed Tomography and Electrocardiographic Exercise Test in Patients With Atypical Chest Pain, Nondiagnostic Electrocardiogram, and Negative Biochemical Markers in the Emergency Department

Acute Coronary Syndromes: Presentation with ACS. ARC and NZRC Guideline 2011

“…In patients with suspected ACS there are a variety of imaging techniques which may be utilised to diagnose acute coronary syndrome. These include CT angiography, MRI, nuclear cardiography and echocardiography 63–77 . Any of these non‐invasive test may be considered in selective patients who present to the ED with chest pain and initial non‐diagnostic conventional work‐up.…”

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

“…77 In contrast, SPECT MPI has been shown to be a cost-effective tool in the early detection of ischemic heart disease in patients with chest pain, contributing substantially to their risk stratification. 56 When used for acute chest pain syndromes, costeffectiveness of rest SPECT MPI has been shown in several studies 27,67,72,78 including a controlled, multicenter trial with true cost data. 21 Similarly, dobutamine-atropine echocardiography 70 as well as contrast echocardiography 65,79 have both been shown to be cost effective in ED patients by reducing admissions, length of stay, and downstream resource utilization.…”

“…Multiple studies, 56 including 2 prospective, randomized, controlled clinical trials, 27,67 have shown clinical utility and effectiveness, 27,66,67,72,73 with very high negative predictive values and clear impact on triage decision-making. The ERASE chest pain study randomly assigned 2456 patients to a strategy of either usual ED care or with a supplemental resting Tc-99m sestamibi scan.…”

“…In fact, low-risk patients with a normal ECG may proceed directly to early ECG stress testing, providing a rapid, low-cost, and definitive evaluation in most cases. [62][63][64] Early stress/rest SPECT MPI 56,[65][66][67][68] and stress echocardiography 69 -71 are also effective techniques. In fact, the sensitivity and negative predictive value of early SPECT (99% to 100%) may exceed that achieved with CCTA.…”

Efficacy of Coronary Revascularization in Patients With Acute Chest Pain Managed in a Chest Pain Unit

“…3 Noninvasive imaging techniques complete the triage process in instances in which patients are unable to exercise. [4][5][6] This exhaustive evaluation reveals a number of patients with significant coronary artery stenosis despite the absence of evidence of ischemia on initial electrocardiography and normal levels of troponin markers. In these cases, unstable angina is usually diagnosed, which is then treated with a revascularization procedure.…”