胸痛患者在急诊科心电图未明确诊断时的早期心肌灌注门控单光子发射计算机断层扫描

[Early myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department].

作者信息

Candell-Riera Jaume, Oller-Martínez Guillermo, Pereztol-Valdés Osvaldo, Castell-Conesa Joan, Aguadé-Bruix Santiago, García-Alonso Carmen, Segura Rosa, Murillo Joaquim, Moreno Rosina, Suriñach Jordi, Soler-Soler Jordi

机构信息

Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

出版信息

Rev Esp Cardiol. 2004 Mar;57(3):225-33.

PMID:15056426

Abstract

OBJECTIVE

To analyze the value of early resting myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department.

PATIENTS AND METHOD

222 patients (49% women, mean age 61 [13] years) with atypical chest pain and with non-diagnostic ECG were randomized into two groups. Group A comprised 111 patients in whom early resting myocardial perfusion gated-SPECT (<6 hours since the end of chest pain) was performed and CK-MB mass and troponin I were determined at 0, 4 and 8 hours. Group B comprised 111 patients with conventional management in the emergency department without gated-SPECT.

RESULTS

Myocardial perfusion gated-SPECT was positive in all 8 patients with increased levels of CK-MB mass and troponin I. This corresponded to a sensitivity and a negative predictive value of 100% for the diagnosis of AMI. Specificity was 84% and positive predictive value was 33% when doubtful results were considered as negative. The number of patients admitted (18.4% vs 32.7%, P<.027) and length of stay (13 [6] hours vs 15.9 [8.6] hours, P<.009) in the emergency department were lower in group A.

CONCLUSIONS

In patients with atypical chest pain and non-diagnostic ECG in the emergency department, early resting gated-SPECT was highly sensitive and showed good negative predictive value for the diagnosis of AMI, but positive predictive value was low. This technique may reduce the number of hospitalized patients and length of stay in the emergency department.

摘要

目的

分析早期静息心肌灌注门控单光子发射计算机断层扫描（gated-SPECT）在急诊科胸痛且心电图无诊断意义患者中的价值。

患者与方法

222例（49%为女性，平均年龄61[13]岁）有非典型胸痛且心电图无诊断意义的患者被随机分为两组。A组111例患者接受早期静息心肌灌注门控SPECT检查（胸痛结束后<6小时），并在0、4和8小时测定肌酸激酶同工酶质量（CK-MB mass）和肌钙蛋白I。B组111例患者在急诊科接受常规治疗，未进行门控SPECT检查。

结果

所有8例CK-MB mass和肌钙蛋白I水平升高的患者心肌灌注门控SPECT均为阳性。这对应于诊断急性心肌梗死（AMI）的敏感性和阴性预测值均为100%。当将可疑结果视为阴性时，特异性为84%，阳性预测值为33%。A组在急诊科的入院患者数量（18.4%对32.7%，P<0.027）和住院时间（13[6]小时对15.9[8.6]小时，P<0.009）较低。