Early Myocardial Perfusion Gated-SPECT in Patients With Chest Pain and Non-Diagnostic ECG in the Emergency Department

Objective To analyze the value of early rest myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department. Patients and method Two hundred and twenty two patients (mean age 61 [13] years, 49% women) with atypical chest pain and non-diagnostic ECG were randomized into 2 groups. Group A patients (n=111) underwent early rest myocardial perfusion gated-SPECT Results The early rest myocardial perfusion gated-SPECT results were positive for all 8 patients with increased CK-MB and troponin I levels. For the diagnosis of acute myocardial infarction, this corresponded to a sensitivity and a negative predictive power of 100%. When doubtful results were considered as negative, specificity was 84% and the positive predictive power 33%. Fewer Group A patients were admitted and their time in the emergency department was shorter (18.4% compared to 32.7% for group B patients, P Conclusions In patients with atypical chest pain and non-diagnostic ECG in the emergency department, early rest myocardial perfusion gated-SPECT was highly sensitive and showed good negative predictive power in the diagnosis of acute myocardial infarction; its positive predictive value, however, was low. This technique may reduce the number of patients hospitalized as well as their length of stay in the emergency department.