Abstract 16400: Impact of Urgent Myocardial Perfusion Imaging with Positron Emission Tomography at the Point of Contact in Chest Pain Patients Presenting to the Emergency Department

Abstract

Myocardial perfusion imaging with PET (PETMPI), is currently the most accurate noninvasive method for the detection of coronary disease. While ideally suited for assessment of chest pain patients in the ED, it has not been previously studied in this context. We performed PETMPI urgently, with an on-site Rubidium-82 generator 24/7, in patients presenting to the ED with chest pain from 2003-2010. Images were acquired over ten minutes at rest, and immediately reconstructed with attenuation correction. Images were wirelessly transmitted immediately after the study, and interpreted with recommendations promptly transmitted to the ED physician: admit to CCU (small ischemic zone at risk), immediately transfer to PCI capable hospital (large zone at risk), or discharge home (no zone at risk). Annual admission rates in 533 sequential chest pain patients evaluated in the ED declined from 73% in 2004 to 23% in 2010, utilizing PETMPI. The mortality rate for patients admitted with the principle diagnosis of acute MI fell from 16% prior to the introduction of PETMPI in the ED to 5%. We conclude that routine use of urgent PETMPI in the ED at the point of contact in chest pain patients, is a cost effective strategy, substantially reducing hospital admission rates, and is associated with improved mortality rates in patients with a principle diagnosis of acute MI.