RESUMO
OBJECTIVE: To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. MATERIAL AND METHODS: Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. RESULTS: Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. CONCLUSION: Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification.
Assuntos
Angina Instável/diagnóstico por imagem , Dor no Peito/diagnóstico por imagem , Serviço Hospitalar de Emergência , Coração/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Doença Aguda , Angina Instável/sangue , Angina Instável/complicações , Fibrilação Atrial/diagnóstico por imagem , Biomarcadores , Dor no Peito/etiologia , Angiografia Coronária , Estudos Transversais , Diagnóstico Diferencial , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/uso terapêutico , Descanso , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Troponina/sangueRESUMO
Objetivo. Evaluar la validez diagnóstica de la gammagrafía de perfusión miocárdica precoz en reposo para la detección de síndrome coronario agudo en pacientes con dolor torácico y electrocardiograma no diagnóstico, comparándola con las técnicas de referencia. Material y métodos. Se realizó una gammagrafía de perfusión miocárdica en 40 de estos pacientes atendidos en el servicio de urgencias, inyectando el radiofármaco en las primeras seis horas tras la finalización del dolor. Todos los sujetos siguieron su curso diagnóstico y terapéutico de rutina. El diagnóstico final de enfermedad coronaria se estableció mediante coronariografía y/o gammagrafía de esfuerzo. Se realizó un tiempo de seguimiento clínico de todos los pacientes entre 9-12 meses. Resultados. El valor predictivo negativo de la gammagrafía de perfusión miocárdica fue del 96,15 % (IC 95 %: 86,84-100,00 %). La principal limitación de su aplicación fue el fenómeno de atenuación mamaria y diafragmática, al no disponer de algoritmos de corrección de atenuación. El índice global de kappa obtenido para valorar la concordancia interobservadores fue del 0,78. Conclusiones. La gammagrafía de perfusión miocárdica en reposo es una técnica eficiente y segura para el screening en urgencias de pacientes con dolor torácico sugestivo de ángor con electrocardiograma normal o no diagnóstico, y proporciona además información pronóstica y estratificación del riesgo
Objective. To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. Material and methods. Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. Results. Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. Conclusion. Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification
Assuntos
Pessoa de Meia-Idade , Humanos , Angina Instável , Dor no Peito , Serviço Hospitalar de Emergência , Coração , Infarto do Miocárdio , Angina Instável/sangue , Angina Instável/complicações , Fibrilação Atrial , Biomarcadores , Dor no Peito/etiologia , Angiografia Coronária , Eletrocardiografia , Hipertensão , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
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