Cost-effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain.

PURPOSE: To determine the cost-effectiveness of promptly performing myocardial perfusion (MP) imaging with single photon emission computed tomography (SPECT) in patients presenting to the emergency department with unexplained chest pain. MATERIALS AND METHODS: Fifty patients with unexplained chest pain underwent MP imaging with SPECT and technetium-99m sestamibi. The cardiologists' management plans before and after receipt of imaging findings were compared. Costs were determined from analysis of comparable admissions for the 6 months before the start of the study. RESULTS: The cardiologists' confidence in their clinical diagnosis significantly increased with use of MP imaging (P<.0001). MP imaging results altered management decisions in 34 patients. Twenty-nine patients were sent home on the basis of imaging findings. None of the patients with a normal MP image experienced a serious adverse cardiac event. The total savings to the hospital was $39,296, or $786 per patient. CONCLUSION: Performing MP imaging in patients with unexplained chest pain while in the emergency department is cost-effective.