Cost-effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain.

Abstract

To determine the cost-effectiveness of promptly performing myocardial perfusion (MP) imaging with single photon emission computed tomography (SPECT) in patients presenting to the emergency department with unexplained chest pain. Fifty patients with unexplained chest pain underwent MP imaging with SPECT and technetium-99m sestamibi. The cardiologists' management plans before and after receipt of imaging findings were compared. Costs were determined from analysis of comparable admissions for the 6 months before the start of the study. The cardiologists' confidence in their clinical diagnosis significantly increased with use of MP imaging (P<.0001). MP imaging results altered management decisions in 34 patients. Twenty-nine patients were sent home on the basis of imaging findings. None of the patients with a normal MP image experienced a serious adverse cardiac event. The total savings to the hospital was $39,296, or $786 per patient. Performing MP imaging in patients with unexplained chest pain while in the emergency department is cost-effective.