Tc-99m Sestamibi in acute chest pain: effect on clinical decision making

Full text: Sestamibi myocardial perfusion imaging, with the injection given during an episode of spontaneous pain (acute sestamibi scan), has been demonstrated to have good diagnostic accuracy and provide prognostic information. This study evaluated the extent to which availability of acute sestamibi scans is likely to modify initial management ol patients presenting to casualty with prolonged chest pain of uncertain origin. 34 patients without diagnostic ECG's were injected with Tc-99m Sestamibi during pain. The referring doctor answered a pre- and postscan questionnaire on diagnosis and management. Patients were followed for results of other investigations and 30 day outcome. Of 7 patients with a positive scan, 4 had a CK rise. Coronary angiography was performed in 5 patients with a positive scan and confirmed significant disease in the artery corresponding to the perfusion defect. One patient with a normal scan had coronary angiography (normal). No patient with a normal/equivocal scan had a cardiac event within 30 days. 30 day mortality in both groups was 0%. This study suggests that acute Sestamibi scans have a significant impact on clinical decision making in two clinical situations. Negative scans in patients with pain of uncertain origin result in avoidance of hospital admissions in a significant number of cases and positive scans could have an impact on the extent of intervention