• Amalia Peix, Elida Batista, Lázaro O Cabrera, Lydia Rodríguez, Kenia Padrón, Benito Saínz, Vladimir Mendoza, Regla Carrillo, Yoel Fernández, Erick Mena, and Maurizio Dondi.
• Departments of Nuclear Medicine, Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu
• Coron. Artery Dis. 2012 Nov 1;23(7):438-44.

ObjectiveTo assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute coronary syndrome (ACS) in emergency department patients, as well as to investigate whether there exists a concordance between MPI and coronary calcium.Materials And MethodsFifty-five patients with chest pain and a normal or nondiagnostic ECG were included. Clinical follow-up was carried out within 1 year.ResultsSixteen patients (29%) showed an abnormal rest MPI, and in 11 (20%) the MPI was equivocal. There was a weak concordance between MPI and coronary arteries calcium score (CACS) (κ: 0.25). Coronary angiogram driven by a positive MPI was performed in 12 patients (23%), resulting in percutaneous coronary intervention in nine cases (75%). A positive MPI (abnormal or equivocal results) was associated with the occurrence of events in the follow-up (χ(2)=19.961, P<0.0001). For a patient presenting to the emergency department with acute chest pain and a normal or nondiagnostic ECG, with a positive MPI, the relative risk of having events during the first year was 7.5 (95% confidence interval: 2.8-19.2), P<0.05, but with a positive CACS this was 1.77 (95% confidence interval: 0.69-4.56), P=NS. At 1 year 68.6% of patients were free of events.ConclusionPatients presenting with acute chest pain and a low-to-intermediate likelihood of coronary artery disease with a normal rest MPI have a very low probability of cardiac events during the first year. Coronary calcium score was not helpful in risk-stratifying these patients.© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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