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Shaukat Ali A, Finnerty V, Harel F, Marquis-Gravel G, Vadeboncoeur A, Pelletier-Galarneau M. Impact of rubidium imaging availability on management of patients with acute chest pain. J Nucl Cardiol 2022; 29:3281-3290. [PMID: 35199279 PMCID: PMC8865882 DOI: 10.1007/s12350-022-02923-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/21/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Evaluate the impact of 82-Rubidium positron emission tomography (PET) myocardial perfusion imaging (MPI) availability on patient management presenting at the emergency department (ED) with chest pain (CP). METHODS This is a single-center retrospective study of clinical databases. Patients presenting with CP with a non-definitive suspicion of acute coronary syndrome (ACS) at the ED between April 2016 and February 2020 were divided into 2 groups based on PET availability. The proportion of invasive coronary angiography (ICA) without significant coronary artery disease (CAD), length of stay (LoS), and additional downstream testing were evaluated. RESULTS There were 21,242 ED visits for CP without definitive ACS: 5,492 when PET is not available and 15,750 when PET is available. When PET is available, proportion of patients undergoing a MPI study was greater (20.7% vs 17.6%, P<0.0001), proportion of ICA without significant CAD was similar (18.5% vs 21.4%, P=0.24), and median ED LoS was shorter (16.6 vs 18.1 hours, P=0.03). Patients undergoing SPECT MPI had significantly more downstream testing (8.9% vs 6.4%, P=0.003) and a higher rate of coronary angiogram without significant CAD (21.2% vs 14.2%, P=0.09) compared to those who underwent PET MPI. CONCLUSION Availability of PET MPI was associated with an increased number of MPI referral from the ED, similar rates of ICA without significant CAD, decreased LoS, and fewer downstream testing.
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Affiliation(s)
- Akasha Shaukat Ali
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC H1T 1C8 Canada
| | - Vincent Finnerty
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC H1T 1C8 Canada
| | - Francois Harel
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC H1T 1C8 Canada
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Grandhi GR, Batlle JC, Maroules CD, Janowitz W, Peña CS, Ziffer JA, Macedo R, Nasir K, Cury RC. Combined stress myocardial CT perfusion and coronary CT angiography as a feasible strategy among patients presenting with acute chest pain to the emergency department. J Cardiovasc Comput Tomogr 2020; 15:129-136. [PMID: 32807703 DOI: 10.1016/j.jcct.2020.06.195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/30/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND A combined approach of myocardial CT perfusion (CTP) with coronary CT angiography (CTA) was shown to have better diagnostic accuracy than coronary CTA alone. However, data on cost benefits and length of stay when compared to other perfusion imaging modalities has not been evaluated. Therefore, we aim to perform a feasibility study to assess direct costs and length of stay of a combined stress CTP/CTA and use SPECT myocardial perfusion imaging (SPECT-MPI) as a benchmark, among chest pain patients at intermediate-risk for acute coronary syndrome (ACS) presenting to the emergency department (ED). METHODS This is a prospective two-arm clinical trial (NCT02538861) with 43 patients enrolled in stress CTP/CTA arm (General Electric Revolution CT) and 102 in SPECT-MPI arm. Mean age of the study population was 65 ± 12 years; 56% were men. We used multivariable linear regression analysis to compare length of stay and direct costs between the two modalities. RESULTS Overall, 9 out of the 43 patients (21%) with CTP/CTA testing had an abnormal test. Of these 9 patients, 7 patients underwent invasive coronary angiography and 6 patients were found to have obstructive coronary artery disease. Normal CTP/CTA test was found in 34 patients (79%), who were discharged home and all patients were free of major adverse cardiac events at 30 days. The mean length of stay was significantly shorter by 28% (mean difference: 14.7 h; 95% CI: 0.7, 21) among stress CTP/CTA (20 h [IQR: 16, 37]) compared to SPECT-MPI (30 h [IQR: 19, 44.5]). Mean direct costs were significantly lower by 44% (mean difference: $1535; 95% CI: 987, 2082) among stress CTA/CTP ($1750 [IQR: 1474, 2114] compared to SPECT-MPI ($2837 [IQR: 2491, 3554]). CONCLUSION Combined stress CTP/CTA is a feasible strategy for evaluation of chest pain patients presenting to ED at intermediate-risk for ACS and has the potential to lead to shorter length of stay and lower direct costs.
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Affiliation(s)
- Gowtham R Grandhi
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Juan C Batlle
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Warren Janowitz
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Constantino S Peña
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Jack A Ziffer
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Robson Macedo
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Ricardo C Cury
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Jain R, Sharma A, Uliel L, Mellnick V, McConathy J. An overview of nuclear medicine studies for urgent and emergent indications. Semin Roentgenol 2014; 49:210-24. [PMID: 24836495 DOI: 10.1053/j.ro.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rashmi Jain
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Akash Sharma
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Livnat Uliel
- Mallinckrodt Institute of Radiology, St. Louis, MO
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Abstract
Acute chest pain suggestive of ischemic cardiac origin, with a normal or nondiagnostic electrocardiogram and negative initial cardiac markers for myocardial necrosis represent a significant diagnostic dilemma for clinicians. Multiple imaging modalities play a pivotal role in early diagnosis and safe discharge of these patients. In this review, we compare the current imaging modalities available for these patients including their diagnostic accuracy, feasibility, and cost effectiveness. Acute rest myocardial perfusion imaging significantly improves the clinical outcome in these patients and reduces the overall cost when incorporated into the decision making pathway. The choice of imaging modality recommended should be based on local institutional expertise and the overall clinical presentation. The imaging modality with high diagnostic accuracy and negative predictive value will provide for precise risk stratification which is important to clinical decision making, including patients who require admission to the hospital and those who can be safely discharged.
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Affiliation(s)
- Abhijit Ghatak
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Chang H, Min JK, Rao SV, Patel MR, Simonetti OP, Ambrosio G, Raman SV. Non-ST-segment elevation acute coronary syndromes: targeted imaging to refine upstream risk stratification. Circ Cardiovasc Imaging 2012; 5:536-46. [PMID: 22811417 DOI: 10.1161/circimaging.111.970699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Henry Chang
- Ohio State University, Columbus, OH 43210, USA
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Mc Ardle B, Ziadi MC, Ruddy TD, Beanlands RS. Nuclear perfusion imaging for functional evaluation of patients with known or suspected coronary artery disease: the future is now. Future Cardiol 2012; 8:603-22. [DOI: 10.2217/fca.12.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nuclear imaging, with both single-photon emission computed tomography and PET, has a well-established role in the assessment of patients with known or suspected coronary artery disease. There is a large body of evidence regarding the diagnostic accuracy and prognostic value of these modalities, however, they continue to evolve rapidly with advances in camera and tracer technology, as well as changes in imaging protocols to increase lab efficiency, improve image quality and to decrease radiation exposure to patients. Nuclear imaging also provides insights into atherogenesis at a molecular level and can be combined with other imaging modalities, providing both functional and structural data and complimentary information on the presence of coronary disease and its functional implications.
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Affiliation(s)
- Brian Mc Ardle
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Maria Cecilia Ziadi
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob S Beanlands
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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