Better N., Karthikeyan G., Vitola J., Fatima A., Peix A., Novak M.D., Soares Jr. J., Bien V.D., Briones P.O., Vangu M., Soni N., Nguyen A., Dondi M.
Departments of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia; All India Institute of Medical Sciences, New Delhi, India; Quanta Diagnostico and Terapia, Curitiba, Brazil; Institute of Nuclear Medicine and Oncology, Lahore, Pakistan; Institute of Cardiology, La Habana, Cuba; University Medical Centre, Ljubljana, Slovenia; Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil; Tran Hung Dao General Hospital, Hanoi, Viet Nam; Pontificia Universidad Católica de Chile, Santiago, Chile; University of the Witwatersrand, Johannesburg, South Africa; University of Pretoria, Pretoria, South Africa; Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Australia; Division of Human Health, International Atomic Energy Agency (IAEA), Vienna, Austria
Better, N., Departments of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia; Karthikeyan, G., All India Institute of Medical Sciences, New Delhi, India; Vitola, J., Quanta Diagnostico and Terapia, Curitiba, Brazil; Fatima, A., Institute of Nuclear Medicine and Oncology, Lahore, Pakistan; Peix, A., Institute of Cardiology, La Habana, Cuba; Novak, M.D., University Medical Centre, Ljubljana, Slovenia; Soares Jr., J., Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil; Bien, V.D., Tran Hung Dao General Hospital, Hanoi, Viet Nam; Briones, P.O., Pontificia Universidad Católica de Chile, Santiago, Chile; Vangu, M., University of the Witwatersrand, Johannesburg, South Africa; Soni, N., University of Pretoria, Pretoria, South Africa; Nguyen, A., Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Australia; Dondi, M., Division of Human Health, International Atomic Energy Agency (IAEA), Vienna, Austria
Background: Rest myocardial perfusion imaging (MPI) is effective in managing patients with acute chest pain in developed countries. We aimed to define the role and feasibility of rest MPI in low-to-middle income countries. Methods and Results: Low-to-intermediate risk patients (n = 356) presenting with chest pain to ten centers in eight developing countries were injected with a Tc-99m-based tracer, and standard imaging was performed. The primary outcome was a composite of death, non-fatal myocardial infarction (MI), recurrent angina, and coronary revascularization at 30 days. Sixty-nine patients had a positive MPI (19.4%), and 52 patients (14.6%) had a primary outcome event. An abnormal rest-MPI result was the only variable which independently predicted the primary outcome [adjusted odds ratio (OR) 8.19, 95% confidence interval 4.10-16.40, P =.0001]. The association of MPI result and the primary outcome was stronger (adjusted OR 17.35) when only the patients injected during pain were considered. Rest-MPI had a negative predictive value of 92.7% for the primary outcome, improving to 99.3% for the hard event composite of death or MI. Conclusions: Our study demonstrates that rest-MPI is a reliable test for ruling out MI when applied to patients in developing countries. © 2012 American Society of Nuclear Cardiology.
technetium 99m; diagnostic agent; methoxy isobutyl isonitrile technetium tc 99m; radiopharmaceutical agent; acute disease; adult; angina pectoris; article; cardiac imaging; cardiovascular mortality; developing country; diagnostic value; differential diagnosis; emergency ward; female; heart infarction; heart muscle revascularization; human; major clinical study; male; multicenter study; myocardial perfusion imaging; outcome assessment; patient coding; predictive value; priority journal; recurrent disease; rest myocardial perfusion imaging; risk assessment; sensitivity and specificity; thorax pain; acute coronary syndrome; developing country; emergency health service; feasibility study; follow up; health; middle aged; pain; rest; scintiscanning; single photon emission computer tomography; thorax pain; Acute Coronary Syndrome; Acute Pain; Chest Pain; Developing Countries; Diagnosis, Differential; Emergency Service, Hospital; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Predictive Value of Tests; Radiopharmaceuticals; Rest; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; World Health