Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: A multicenter study

Sanjiv Kaul, Roxy Senior, Christian Firschke, Xin Qun Wang, Jonathan Lindner, Flordeliza S. Villanueva, Soroosh Firozan, Michael C. Kontos, Allen Taylor, Ian J. Nixon, Denny D. Watson, Frank E. Harrell

Research output: Contribution to journalArticle

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Abstract

Background We hypothesized that imaging of regional myocardial function (RF) and perfusion (PER) will add incremental value for both diagnosis and short-term prognosis to routine demographic, clinical, and electrocardiographic findings in patients presenting to the emergency department (ED) with chest pain and without ST-segment elevation on the electrocardiogram. Methods We compared contrast echocardiography (CE) with gated single-photon emission computed tomography (SPECT) for this purpose. Both CE and SPECT readings included separate and composite assessments of both RF and PER. Adverse events in the first 48 hours after ED presentation included acute myocardial infarction, emergent revascularization, and cardiac-related death. Results Concordance between CE and SPECT was 77% (73% to 82%) for all territories, with a higher concordance for the anterior wall of 84% (78% to 89%). Of the 203 patients recruited for the study, 38 (19%) had a cardiac event within 48 hours of ED presentation: 21 had acute myocardial infarction, 16 underwent an urgent revascularization procedure, and 1 died. In multivariate logistic regression models, the number of abnormal segments on CE and SPECT were significant predictors (P <.05) of cardiac events. The composite scores on CE provided 17% incremental information (P = .009, n = 203) and gated SPECT provided 23.5% additional information (P = .020, n = 163) for predicting cardiac events compared with routine demographic, clinical, and electrocardiographic variables. RF and composite evaluation was superior on SPECT compared with CE, whereas PER alone was not. Conclusions Cardiac imaging of RF and PER at the time of ED presentation offers substantially greater diagnostic and prognostic information for early cardiac events in patients presenting to the ED with chest pain and no ST elevation than does the routine demographic, clinical, and electrocardiographic assessment.

Original languageEnglish (US)
Pages (from-to)129-136
Number of pages8
JournalAmerican Heart Journal
Volume148
Issue number1
DOIs
StatePublished - Jul 2004
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Chest Pain
Multicenter Studies
Echocardiography
Hospital Emergency Service
Perfusion
Demography
Logistic Models
Myocardial Infarction
Reading
Electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation : A multicenter study. / Kaul, Sanjiv; Senior, Roxy; Firschke, Christian; Wang, Xin Qun; Lindner, Jonathan; Villanueva, Flordeliza S.; Firozan, Soroosh; Kontos, Michael C.; Taylor, Allen; Nixon, Ian J.; Watson, Denny D.; Harrell, Frank E.

In: American Heart Journal, Vol. 148, No. 1, 07.2004, p. 129-136.

Research output: Contribution to journalArticle

Kaul, S, Senior, R, Firschke, C, Wang, XQ, Lindner, J, Villanueva, FS, Firozan, S, Kontos, MC, Taylor, A, Nixon, IJ, Watson, DD & Harrell, FE 2004, 'Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: A multicenter study', American Heart Journal, vol. 148, no. 1, pp. 129-136. https://doi.org/10.1016/j.ahj.2003.12.041
Kaul, Sanjiv ; Senior, Roxy ; Firschke, Christian ; Wang, Xin Qun ; Lindner, Jonathan ; Villanueva, Flordeliza S. ; Firozan, Soroosh ; Kontos, Michael C. ; Taylor, Allen ; Nixon, Ian J. ; Watson, Denny D. ; Harrell, Frank E. / Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation : A multicenter study. In: American Heart Journal. 2004 ; Vol. 148, No. 1. pp. 129-136.
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abstract = "Background We hypothesized that imaging of regional myocardial function (RF) and perfusion (PER) will add incremental value for both diagnosis and short-term prognosis to routine demographic, clinical, and electrocardiographic findings in patients presenting to the emergency department (ED) with chest pain and without ST-segment elevation on the electrocardiogram. Methods We compared contrast echocardiography (CE) with gated single-photon emission computed tomography (SPECT) for this purpose. Both CE and SPECT readings included separate and composite assessments of both RF and PER. Adverse events in the first 48 hours after ED presentation included acute myocardial infarction, emergent revascularization, and cardiac-related death. Results Concordance between CE and SPECT was 77{\%} (73{\%} to 82{\%}) for all territories, with a higher concordance for the anterior wall of 84{\%} (78{\%} to 89{\%}). Of the 203 patients recruited for the study, 38 (19{\%}) had a cardiac event within 48 hours of ED presentation: 21 had acute myocardial infarction, 16 underwent an urgent revascularization procedure, and 1 died. In multivariate logistic regression models, the number of abnormal segments on CE and SPECT were significant predictors (P <.05) of cardiac events. The composite scores on CE provided 17{\%} incremental information (P = .009, n = 203) and gated SPECT provided 23.5{\%} additional information (P = .020, n = 163) for predicting cardiac events compared with routine demographic, clinical, and electrocardiographic variables. RF and composite evaluation was superior on SPECT compared with CE, whereas PER alone was not. Conclusions Cardiac imaging of RF and PER at the time of ED presentation offers substantially greater diagnostic and prognostic information for early cardiac events in patients presenting to the ED with chest pain and no ST elevation than does the routine demographic, clinical, and electrocardiographic assessment.",
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T1 - Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation

T2 - A multicenter study

AU - Kaul, Sanjiv

AU - Senior, Roxy

AU - Firschke, Christian

AU - Wang, Xin Qun

AU - Lindner, Jonathan

AU - Villanueva, Flordeliza S.

AU - Firozan, Soroosh

AU - Kontos, Michael C.

AU - Taylor, Allen

AU - Nixon, Ian J.

AU - Watson, Denny D.

AU - Harrell, Frank E.

PY - 2004/7

Y1 - 2004/7

N2 - Background We hypothesized that imaging of regional myocardial function (RF) and perfusion (PER) will add incremental value for both diagnosis and short-term prognosis to routine demographic, clinical, and electrocardiographic findings in patients presenting to the emergency department (ED) with chest pain and without ST-segment elevation on the electrocardiogram. Methods We compared contrast echocardiography (CE) with gated single-photon emission computed tomography (SPECT) for this purpose. Both CE and SPECT readings included separate and composite assessments of both RF and PER. Adverse events in the first 48 hours after ED presentation included acute myocardial infarction, emergent revascularization, and cardiac-related death. Results Concordance between CE and SPECT was 77% (73% to 82%) for all territories, with a higher concordance for the anterior wall of 84% (78% to 89%). Of the 203 patients recruited for the study, 38 (19%) had a cardiac event within 48 hours of ED presentation: 21 had acute myocardial infarction, 16 underwent an urgent revascularization procedure, and 1 died. In multivariate logistic regression models, the number of abnormal segments on CE and SPECT were significant predictors (P <.05) of cardiac events. The composite scores on CE provided 17% incremental information (P = .009, n = 203) and gated SPECT provided 23.5% additional information (P = .020, n = 163) for predicting cardiac events compared with routine demographic, clinical, and electrocardiographic variables. RF and composite evaluation was superior on SPECT compared with CE, whereas PER alone was not. Conclusions Cardiac imaging of RF and PER at the time of ED presentation offers substantially greater diagnostic and prognostic information for early cardiac events in patients presenting to the ED with chest pain and no ST elevation than does the routine demographic, clinical, and electrocardiographic assessment.

AB - Background We hypothesized that imaging of regional myocardial function (RF) and perfusion (PER) will add incremental value for both diagnosis and short-term prognosis to routine demographic, clinical, and electrocardiographic findings in patients presenting to the emergency department (ED) with chest pain and without ST-segment elevation on the electrocardiogram. Methods We compared contrast echocardiography (CE) with gated single-photon emission computed tomography (SPECT) for this purpose. Both CE and SPECT readings included separate and composite assessments of both RF and PER. Adverse events in the first 48 hours after ED presentation included acute myocardial infarction, emergent revascularization, and cardiac-related death. Results Concordance between CE and SPECT was 77% (73% to 82%) for all territories, with a higher concordance for the anterior wall of 84% (78% to 89%). Of the 203 patients recruited for the study, 38 (19%) had a cardiac event within 48 hours of ED presentation: 21 had acute myocardial infarction, 16 underwent an urgent revascularization procedure, and 1 died. In multivariate logistic regression models, the number of abnormal segments on CE and SPECT were significant predictors (P <.05) of cardiac events. The composite scores on CE provided 17% incremental information (P = .009, n = 203) and gated SPECT provided 23.5% additional information (P = .020, n = 163) for predicting cardiac events compared with routine demographic, clinical, and electrocardiographic variables. RF and composite evaluation was superior on SPECT compared with CE, whereas PER alone was not. Conclusions Cardiac imaging of RF and PER at the time of ED presentation offers substantially greater diagnostic and prognostic information for early cardiac events in patients presenting to the ED with chest pain and no ST elevation than does the routine demographic, clinical, and electrocardiographic assessment.

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