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Resting Radionuclide Myocardial Perfusion Imaging in a Chest Pain Center Including an Overnight Delayed Image Acquisition Protocol

¹ Division of Cardiovascular Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ² Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio; ³ E.L. Saenger Radioisotope Laboratory, University Hospital of Cincinnati, Cincinnati, Ohio; ⁴ Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; and ⁵ Division of Cardiovascular Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio

Correspondence: For correspondence or reprints contact: Myron C. Gerson, MD, Division of Cardiovascular Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio 45267-0542. E-mail: gersonml{at}ucmail.uc.edu

Emergency department (ED) patients with chest pain (CP) and a nondiagnostic electrocardiogram (ECG) present difficult management decisions. The purpose of this study was to investigate the utility of resting radionuclide SPECT myocardial perfusion imaging (SPECT MPI)—including an overnight delayed image acquisition protocol—in identifying patients presenting to the ED with CP at risk for cardiac events. Methods: Patients presenting to the ED with CP and a nondiagnostic ECG were prospectively enrolled and underwent chest pain center evaluation. All patients also underwent resting gated SPECT MPI using ^99mTc-tetrofosmin tracer. Patients presenting on weeknights between 12 AM and 6 AM had tracer injection in the ED with image acquisition delayed until later in the morning. Patients were monitored for a 30-d occurrence of cardiac events. Results: Over a 16-mo period, 479 patients were enrolled and completed follow-up. For the prediction of 30-d cardiac events, resting SPECT MPI demonstrated a sensitivity and a specificity of 76.9% and 92.4%, respectively. Positive and negative predictive values were 22.2% and 99.3%, respectively. Among the 3 patients with a normal perfusion scan who suffered cardiac events, all had tracer injection several hours after resolution of CP. The overnight delayed image acquisition protocol provided a negative predictive value of 100% for the 44 patients whose image acquisition was delayed until the following morning. Conclusion: A normal resting SPECT MPI in ED patients presenting with CP predicts a very low occurrence of 30-d cardiac events. A delayed image acquisition protocol did not decrease the accuracy of SPECT MPI. Such a protocol may be useful in increasing the availability of this imaging modality.