Key result
Resting sestamibi scanning was highly discriminating, with adverse cardiac events occurring in 62% of patients with positive scans compared to 3% with negative scans (p<0.001).
Why the study?
Does resting Tc-99m sestamibi scanning predict adverse cardiac events in emergency department patients with low-risk chest pain?
Cohort (n=69)
Does resting Tc-99m sestamibi scanning predict adverse cardiac events in emergency department patients with low-risk chest pain?
Absolute Event Rate: 62% vs 3%
p-value: p=<0.001
Resting sestamibi imaging provides high specificity and negative predictive value for ruling out 1-year adverse cardiac events in emergency department patients with low-risk chest pain.
May aid ED risk stratification in low-probability chest pain; leaves open whether routine use improves outcomes.
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.
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Kosnik et al. (1999) conducted a cohort in Low-risk chest pain (n=69). Resting Tc-99m sestamibi scanning vs. Negative scan was evaluated on Adverse cardiac events (ACEs) of myocardial infarction (MI), death, or revascularization (p=<0.001). Resting sestamibi scanning was highly discriminating, with adverse cardiac events occurring in 62% of patients with positive scans compared to 3% with negative scans (p<0.001).
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