Usefulness of two-dimensional echocardiography and myocardial perfusion imaging for immediate evaluation of chest pain in the emergency department.

Abstract

Accurate identification of patients in the emergency department at high risk of acute coronary syndrome with possible myocardial ischaemia and a nonischaemic electrocardiogram is problematic. Both two-dimensional echocardiography and myocardial perfusion imaging with technetium-99m-sestamibi can identify patients at low and high risk, however comparative studies are lacking. We studied 655 consecutively patients considered at low or moderate risk for myocardial ischaemia in our Emergency Department (ED). On the basis of the presenting history, physical examination, and electrocardiogram they underwent both echocardiography and myocardial perfusion imaging within 4 h of ED presentation. End points included myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA) and positive stress perfusion imaging. Both imaging procedures were performed in the ED on 470 patients. Overall agreement between the two techniques was high (concordance 90%) in the patients who had myocardial infarction or underwent coronary angiography. Agreement between the two imaging techniques is high when used in patients with possible myocardial ischaemia. Both techniques identified patients at high risk who required admission and those who could be safely discharged directly from the ED.