The role of myocardial perfusion scintigraphy in the assessment of patients attending a rapid access chest pain clinic
Abstract
A retrospective audit of the utility of myocardial perfusion scintigraphy (MPS) in the investigation and management of patients from a newly established rapid access chest pain clinic (RACPC) was performed. Between 1 May 2002 and 31 July 2003 259 patients were seen in the RACPC of whom 89 (34%) were referred for MPS. Eighty-five (96%) patients attended for imaging. Forty-seven of the 85 (55%) studies were normal, 35 (41%) were abnormal showing inducible ischaemia (30), infarction (2) or a combination of these two (3) and in 3 (4%) cases there were minor abnormalities on low risk studies of uncertain aetiology. The 47 patients with normal MPS were discharged from RACPC with risk factor advice and medical therapy as appropriate. To date 13/35 (37%) patients with markedly abnormal MPS studies (moderate/severe ischaemia or scans suggestive of LAD or multivessel disease) have undergone coronary angiography and this was abnormal in all cases. Eleven (85%) of these have proceeded to coronary intervention (2 CABG, 9 PCI) with two continuing on medical therapy. Three additional patients with minor scan abnormalities required invasive investigation on clinical grounds and this was normal. It is concluded that MPS allows effective risk stratification of patients from RACPC allowing reassurance and discharge of patients at low risk and directing invasive evaluation in the remainder.