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Nuclear scan strategy and outcomes in chest pain patients value of stress testing with dipyridamole or adenosine.

Conti A, Mariannini Y, Canuti E, Petrova T, Innocenti F, Zanobetti M, Gallini C, Costanzo E - World J Nucl Med (2014)

Bottom Line: Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively).In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT.Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy.

ABSTRACT

Objective: To update the prognostic value of scan strategy with pharmacological stress agent in chest pain (CP) patients presenting with normal electrocardiography (ECG) and troponin.

Methods: Two consecutive nonrandomized series of patients with CP and negative first-line workup inclusive of serial ECG, serial troponin, and echocardiography underwent myocardial perfusion imaging single photon emission computed tomography (SPECT) in the emergency department. Of 170 patients enrolled, 52 patients underwent dipyridamole-SPECT and 118 adenosine-SPECT. Patients with perfusion defects underwent angiography, whereas the remaining patients were discharged and followed-up. Primary endpoint was the composite of nonfatal myocardial infarction, unstable angina, revascularization, and cardiovascular death at follow-up or the presence of coronary stenosis > 50% at angiography.

Results: At multivariate analysis, the presence of perfusion defects or hypertension was independent predictor of the primary endpoint. Sensitivity and negative predictive value were higher in patients subjected to adenosine-SPECT (95% and 99%, respectively) versus dipyridamole-SPECT (56% and 89%; yield 70% and 11%, respectively; P < 0.03). Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively).

Conclusions: In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT. Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of chest pain patients to the Emergency Department between 2007 and 2011
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Figure 1: Flow diagram of chest pain patients to the Emergency Department between 2007 and 2011

Mentions: Baseline clinical characteristics of enrolled patients are shown in Table 1. The two series of patients did not show any significant clinical differences. One-half of patients presented hypertension; 19% had diabetes or high blood cholesterol. The mean age was 69 years, 58% of patients were female and 13% presented with basal nonischemic ECG or basal nonischemic echocardiography alterations. The flow diagram of CP patients to the emergency department between 2007 and 2011 years is shown in Figure 1. Of 170 patients enrolled, 52 underwent stress dipyridamole-SPECT and the remaining 118 underwent stress adenosine-SPECT. Results of SPECT and outcomes are shown in Figure 2. The presence of perfusion defects or the presence of hypertension or basal nonischemic echocardiography alterations were predictor of the composite endpoint at univariate analysis; however, at multivariate regression analysis by backward stepwise only the presence of perfusion defects or the presence of hypertension were independent predictors of the composite endpoint [Table 2].


Nuclear scan strategy and outcomes in chest pain patients value of stress testing with dipyridamole or adenosine.

Conti A, Mariannini Y, Canuti E, Petrova T, Innocenti F, Zanobetti M, Gallini C, Costanzo E - World J Nucl Med (2014)

Flow diagram of chest pain patients to the Emergency Department between 2007 and 2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150166&req=5

Figure 1: Flow diagram of chest pain patients to the Emergency Department between 2007 and 2011
Mentions: Baseline clinical characteristics of enrolled patients are shown in Table 1. The two series of patients did not show any significant clinical differences. One-half of patients presented hypertension; 19% had diabetes or high blood cholesterol. The mean age was 69 years, 58% of patients were female and 13% presented with basal nonischemic ECG or basal nonischemic echocardiography alterations. The flow diagram of CP patients to the emergency department between 2007 and 2011 years is shown in Figure 1. Of 170 patients enrolled, 52 underwent stress dipyridamole-SPECT and the remaining 118 underwent stress adenosine-SPECT. Results of SPECT and outcomes are shown in Figure 2. The presence of perfusion defects or the presence of hypertension or basal nonischemic echocardiography alterations were predictor of the composite endpoint at univariate analysis; however, at multivariate regression analysis by backward stepwise only the presence of perfusion defects or the presence of hypertension were independent predictors of the composite endpoint [Table 2].

Bottom Line: Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively).In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT.Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy.

ABSTRACT

Objective: To update the prognostic value of scan strategy with pharmacological stress agent in chest pain (CP) patients presenting with normal electrocardiography (ECG) and troponin.

Methods: Two consecutive nonrandomized series of patients with CP and negative first-line workup inclusive of serial ECG, serial troponin, and echocardiography underwent myocardial perfusion imaging single photon emission computed tomography (SPECT) in the emergency department. Of 170 patients enrolled, 52 patients underwent dipyridamole-SPECT and 118 adenosine-SPECT. Patients with perfusion defects underwent angiography, whereas the remaining patients were discharged and followed-up. Primary endpoint was the composite of nonfatal myocardial infarction, unstable angina, revascularization, and cardiovascular death at follow-up or the presence of coronary stenosis > 50% at angiography.

Results: At multivariate analysis, the presence of perfusion defects or hypertension was independent predictor of the primary endpoint. Sensitivity and negative predictive value were higher in patients subjected to adenosine-SPECT (95% and 99%, respectively) versus dipyridamole-SPECT (56% and 89%; yield 70% and 11%, respectively; P < 0.03). Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively).

Conclusions: In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT. Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.

No MeSH data available.


Related in: MedlinePlus