- Email: [email protected]
DOWNSTREAM CORONARY ANGIOGRAPHY AND REVASCULARIZATION AFTER ABNORMAL MYOCARDIAL PERFUSION IMAGING IN PATIENTS WITH POSSIBLE ACUTE CORONARY SYNDROMES PRESENTING TO THE EMERGENCY DEPARTMENT
A57 JACC April 1, 2014 Volume 63, Issue 12
Acute Coronary Syndromes Downstream Coronary Angiography and Revascularization after Abnormal Myocardial Perfusion Imaging in Patients with Possible Acute Coronary Syndromes Presenting to the Emergency Department Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:45 a.m.
Session Title: Acute Coronary Syndromes: NSTEMI Abstract Category: 1. Acute Coronary Syndromes: Clinical Presentation Number: 1117-235 Authors: Paul Cremer, Shaden Khalaf, Ellen Mayer Sabik, Manuel Cerqueira, Venu Menon, Wael Jaber, Cleveland Clinic Foundation, Cleveland, OH, USA Background: After negative cardiac biomarkers, many patients with possible acute coronary syndromes (ACS) are further risk stratified with myocardial perfusion imaging. We investigated whether rest-stress single photon emission computed tomography (SPECT) could identify patients with possible ACS that would realize a survival benefit with early revascularization. Methods: At our institution, we identified consecutive patients with possible ACS referred from the emergency department for rest-stress SPECT from October 2004 through December 2011. All patients had at least two negative serial cardiac troponin T tests. We assessed rates of coronary angiography and revascularization within 30 days of rest-stress SPECT. All cause mortality was determined from the social security death index. Results: Among 6,068 patients, 589 (9.7%) had coronary angiography, and 203 (3.3%) underwent revascularization. The severity of rest-stress SPECT abnormality predicted obstructive CAD and revascularization.) After a median follow-up of 4.8 years, there were 434 deaths (7.2%). There was no degree of ischemia that predicted improved survival with early revascularization. Conclusions: In low risk patients with possible ACS, although angiography and revascularization tracked degree of ischemia, we were unable to demonstrate an ischemic threshold that identified patients with improved survival upon early revascularization. These patients should initially be managed conservatively.
Acute Coronary Syndromes Downstream Coronary Angiography and Revascularization after Abnormal Myocardial Perfusion Imaging in Patients with Possible Acute Coronary Syndromes Presenting to the Emergency Department Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:45 a.m.
Session Title: Acute Coronary Syndromes: NSTEMI Abstract Category: 1. Acute Coronary Syndromes: Clinical Presentation Number: 1117-235 Authors: Paul Cremer, Shaden Khalaf, Ellen Mayer Sabik, Manuel Cerqueira, Venu Menon, Wael Jaber, Cleveland Clinic Foundation, Cleveland, OH, USA Background: After negative cardiac biomarkers, many patients with possible acute coronary syndromes (ACS) are further risk stratified with myocardial perfusion imaging. We investigated whether rest-stress single photon emission computed tomography (SPECT) could identify patients with possible ACS that would realize a survival benefit with early revascularization. Methods: At our institution, we identified consecutive patients with possible ACS referred from the emergency department for rest-stress SPECT from October 2004 through December 2011. All patients had at least two negative serial cardiac troponin T tests. We assessed rates of coronary angiography and revascularization within 30 days of rest-stress SPECT. All cause mortality was determined from the social security death index. Results: Among 6,068 patients, 589 (9.7%) had coronary angiography, and 203 (3.3%) underwent revascularization. The severity of rest-stress SPECT abnormality predicted obstructive CAD and revascularization.) After a median follow-up of 4.8 years, there were 434 deaths (7.2%). There was no degree of ischemia that predicted improved survival with early revascularization. Conclusions: In low risk patients with possible ACS, although angiography and revascularization tracked degree of ischemia, we were unable to demonstrate an ischemic threshold that identified patients with improved survival upon early revascularization. These patients should initially be managed conservatively.