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Emergency department (ED) triage decisions can be improved for diabetes patients who arrive at the ED with chest pain or other symptoms that suggest acute cardiac ischemia (ACI, reduced blood flow to the heart) with use of single photon emission computed tomography (SPECT) imaging with technetium 99m (Tc-99m) sestamibi. That's the conclusion of a study supported in part by the Agency for Healthcare Research and Quality (HS09110).
In the main multicenter trial of ED evaluation strategies, 2,475 patients with symptoms suggestive of ACI and normal or nondiagnostic electrocardiograms were randomized to receive either the usual ED evaluation strategy (1,260 patients) or the usual strategy supplemented by results from SPECT Tc-99m imaging (1,215 patients). Harry P. Selker, M.D., M.S.P.H., of Tufts-New England Medical Center, and his colleagues compared imaging results, final diagnoses, effect on triage, and prognostic value of the SPECT imaging for diabetes and nondiabetes patients.
Patients with diabetes had higher rates of hospitalization (66 vs. 50 percent) and ACI (21 vs. 12 percent) than patients without diabetes. Among diabetes patients without ACI, the admission rate was 63 percent in the usual strategy group versus 54 percent in the imaging strategy group. Thus, SPECT imaging reduced unnecessary hospitalizations for this group and for patients without diabetes. At the same time, the appropriate hospitalization of patients with ACI was not affected. Moreover, among diabetes patients, an abnormal or equivocal SPECT imaging result was associated with a higher cardiovascular event rate (for example, stroke or heart attack) at 30 days compared with a normal imaging result.
More details are in "Acute resting myocardial perfusion imaging in patients with diabetes mellitus: Results from the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial," by Athanasios Kapetanopoulos, M.D., Gary V. Heller, M.D., Ph.D., Dr. Selker, and others, in the September 2004 Journal of Nuclear Cardiology 11, pp. 570-577.
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