Pretest probability assessment for selective rest sestamibi scans in stable chest pain patients - 05/09/11

Doi : 10.1053/ajem.2000.18030

Robert D. Welch, MD ^*,^†,^‡, Robert J. Zalenski, MD ^*, Falah Shamsa, PhD ^*, Denise R. Waselewsky, BS ^*, Joseph W. Kosnik, MD ^*,^†,^§, Scott Compton, MEd ^*,
^* Wayne State University School of Medicine, Detroit, MI
^† Detroit Receiving Hospital, Detroit, MI
^‡ Harper Hospital, Detroit, MI
^§ Huron Valley-Sinai Hospital, Commerce Township, MI
William Beaumont Hospital, Royal Oak, MI.

Abstract

The objective of this study was to determine whether pretest probability assessments permit more selective testing of chest pain patients with technetium-99m sestamibi scanning. Pretest probabilities of cardiac ischemia were measured both objectively (Acute Cardiac Ischemia Time-Insensitive Predictive Instrument [ACI-TIPI]) and subjectively (physician's estimate of the probability of unstable angina). Two groups were defined: patients whose postsestamibi scan led to a “downgrade” of the intensity of monitoring and those that resulted in no change in monitoring intensity. Sixty-five patients met study criteria; 25 had a disposition downgrade and 40 had no change. Pretest ACI-TIPI scores were similar in the two groups (29% ± 18% versus 27% ± 11%, mean ± standard deviation; P = .95) as were the physician's assessment of unstable angina (39% ± 22% versus 40% ± 24%; P = .75). Objective or subjective pretest probabilities are not significantly different in patients who are likely to have their disposition altered by sestamibi scanning. (Am J Emerg Med 2000;18:789-792. Copyright © 2000 by W.B. Saunders Company)

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Keywords : Sestamibi, pretest probability, acute cardiac ischemia, chest pain, myocardial infarction, unstable angina, emergency physician, emergency department

Plan

	Supported by the Emergency Medicine Foundation, Dupont Pharma, and the Center for Healthcare Effectiveness Research at Wayne State University School of Medicine, Detroit, MI.
	Address reprint requests to Robert D. Welch, MD, Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI 40201. E-mail rwelch@med.wayne.edu
	Am J Emerg Med 2000;18:789-792
	0735-6757/00/1807-0009$10.00/0