Current diagnostic methods for ACS in the ED, however, are clearly suboptimal. As a result, “rule-out” admissions are very common, and 7 out of 10 patients admitted for suspected ACS prove not to have it [1,3]. Also, many cases of ACS are diagnosed only after lengthy observation, with a resulting delay in therapy and an impaired prognosis. As many as 2–5% of those with ACS are erroneously sent home
from the ED [4,5]. To overcome these problems, several new diagnostic methods have been suggested [6], e.g. echocardiography [7], multidetector CT scanning [8] and nuclear myocardial perfusion imaging (MPI) [9]. Acute MPI has been shown to be of value Inhibitors,research,lifescience,medical in routine care in the USA [10,11], primarily because of a high negative predictive value for Inhibitors,research,lifescience,medical ACS in patients with ongoing or recently abated chest pain and a non-diagnostic ECG. MPI may thus accurately identify patients who can be safely discharged directly from the ED. US studies also show that acute MPI can be cost effective[12]. To our knowledge however, no European study has yet evaluated the economy of acute MPI. Inhibitors,research,lifescience,medical In the present study, the aim was to evaluate the utility and AZD6244 cost hospital economics of acute MPI in Swedish ED patients with suspected ACS. Methods Institution and patient material Lund University Hospital
(USiL) is a 1200 bed institution with fully public financing that serves a population of some 250 000, and has some 65 000
ED visits per year. Percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) are available 24 hours/day. After Inhibitors,research,lifescience,medical informed consent, we prospectively included a convenience sample of 40 patients with chest pain suspicious of ACS attending the ED at USiL from 2002 to 2006. During the inclusion period, there was no systematic diagnostic protocol for patients with suspected ACS, no dedicated chest pain unit, and no formal strategy for admitting ED patients to in-hospital care. However, most admitted patients underwent serial blood testing and ECGs, as well as a pre-discharge Inhibitors,research,lifescience,medical exercise ECG when necessary. As far as known, no significant change in the usual below care took place over the inclusion period. Inclusion and exclusion criteria are shown in figure figure11. Figure 1 Inclusion/exclusion criteria and diagnostic protocol. Discharge diagnoses were made by the responsible physician according to European Society of Cardiology/American College of cardiology consensus documents using Troponin T as the critical biomarker [13], with a cut-off at 0.05 μg/L. In the study, diagnoses were noted “as is” from the patient records, and no further review was made. For patients with normal MPI results, the computerized patient records at USiL were used to identify ischemic cardiac events at 6 months after the index visit.
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