Abbott B G, Abdel-Aziz I, Nagula S, Monico E P, Schriver J A, Wackers F J
The Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-0817, USA.
Am J Cardiol. 2001 Jun 15;87(12):1351-5. doi: 10.1016/s0002-9149(01)01551-x.
Emergency department chest pain centers (CPCs) vary in their approach to patients with chest pain and nonischemic electrocardiograms (ECG). Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stress, we questioned its application in all patients. We prospectively evaluated the utility of selective SPECT imaging in a CPC (i.e., rest SPECT for ongoing pain, stress SPECT if unable to undergo exercise electrocardiography) and its impact on the overall disposition of all emergency department chest pain patients. Over 3 years, 2,601 patients were evaluated in a CPC (2,211 [85%] were sent home, 390 [15%] were hospitalized). Of 390 CPC patients hospitalized, 182 (47%) were diagnosed with coronary artery disease at the time of hospital discharge. Only 28 patients (1.1%) had an acute myocardial infarction. After 3 years, the proportion of all chest pain patients hospitalized and those diagnosed as "rule-out myocardial infarction" decreased from 53% to 41% and 32% to 18% of all chest pain patients, respectively (both p <0.0001). Overall, 906 patients (35%) required SPECT imaging to complete the CPC evaluation. Had SPECT imaging not been performed selectively, and all 906 patients been admitted, 762 (29%) would have been hospitalized unnecessarily based on the final diagnoses. Alternatively, sending all these patients home would have resulted in 144 (6%) inappropriate discharges of patients with coronary artery disease. A CPC protocol using the selective use of SPECT imaging permits the complete evaluation of all patients in the CPC, significantly reduces hospitalizations for chest pain, and restricts hospital admission to more appropriate patients.
急诊科胸痛中心（CPC）对胸痛且心电图无缺血表现的患者采取的诊疗方法各不相同。尽管单光子发射计算机断层扫描（SPECT）心肌灌注成像已在此类情况下进行了评估，包括静息时急性评估以及负荷后评估，但我们对其在所有患者中的应用提出质疑。我们前瞻性地评估了选择性SPECT成像在胸痛中心的效用（即持续疼痛时行静息SPECT成像，若无法进行运动心电图检查则行负荷SPECT成像）及其对所有急诊科胸痛患者总体处置的影响。在3年多的时间里，胸痛中心对2601例患者进行了评估（2211例[85%]被送回家，390例[15%]住院）。在390例住院的胸痛中心患者中，182例（47%）在出院时被诊断为冠状动脉疾病。只有28例患者（1.1%）发生急性心肌梗死。3年后，所有胸痛住院患者以及被诊断为“排除心肌梗死”的患者比例分别从所有胸痛患者的53%降至41%、从32%降至18%（均p<0.0001）。总体而言，906例患者（35%）需要SPECT成像来完成胸痛中心评估。若未选择性地进行SPECT成像，而是让所有906例患者住院，根据最终诊断，762例（29%）将被不必要地住院。相反，将所有这些患者送回家会导致144例（6%）冠状动脉疾病患者不适当出院。采用选择性使用SPECT成像的胸痛中心方案能够对胸痛中心的所有患者进行全面评估，显著减少胸痛患者的住院率，并将住院收治限制在更合适的患者身上。
