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Title: Stress myocardial perfusion imaging for the evaluation and triage of chest pain in the emergency department: A randomized controlled trial
Authors: Lim, S.H.
Anantharaman, V.
Sundram, F.
Chan, E.S.-Y.
Ang, E.S.
Yo, S.L.
Jacob, E.
Goh, A.
Tan, S.B. 
Chua, T.
Keywords: acute chest pain
acute coronary syndrome
Cardiac event
cardiac troponin
emergency department
risk stratification
Issue Date: Dec-2013
Citation: Lim, S.H., Anantharaman, V., Sundram, F., Chan, E.S.-Y., Ang, E.S., Yo, S.L., Jacob, E., Goh, A., Tan, S.B., Chua, T. (2013-12). Stress myocardial perfusion imaging for the evaluation and triage of chest pain in the emergency department: A randomized controlled trial. Journal of Nuclear Cardiology 20 (6) : 1002-1012. ScholarBank@NUS Repository.
Abstract: Background: Patients with acute coronary syndrome (ACS) often present atypically. In a randomized controlled trial, we studied whether adding stress myocardial perfusion imaging (SMPI) to an evaluation strategy for emergency department (ED) patients presenting with chest pain more effectively identifies patients with ACS. Methods: Participants were randomized to standard ED chest pain protocol (clinical assessment) or standard protocol supplemented with SMPI results. During 6 hours of electrocardiogram (ECG) monitoring and serial cardiac markers (creatine kinase-MB isoenzyme, troponin), participants developing ST segment changes or elevated cardiac markers were admitted. Those with a negative observation period underwent SMPI (N = 1,004) or clinical assessment (N = 504) based on randomization, and admitted if their SMPI scan was abnormal or senior clinicians found a high or intermediate risk for ACS. Results: SMPI participants had a significantly lower admission rate than clinical assessment participants (10.16% vs 18.45%), with no significant between-group differences in risk of cardiac events (CEs) after 30 days (0.40% vs 0.79%) or 1 year (0.70% vs 0.99%). Conclusions: When added to a standard triage strategy incorporating clinical evaluation, serial ECGs, and cardiac markers, SMPI improved clinical decision making for chest pain patients, significantly reducing the need for hospitalization without an increase in adverse CE rates at 30 days or 1 year. © 2013 American Society of Nuclear Cardiology.
Source Title: Journal of Nuclear Cardiology
ISSN: 10713581
DOI: 10.1007/s12350-013-9736-9
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