BACKGROUND: Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes. METHODS: Serum markers and acute technetium-99m sestamibi/tetrofosmin rest MPI were obtained in 75 patients admitted to the ED with chest pain and nondiagnostic electrocardiograms. Venous samples were drawn at admission and 8 to 24 hours later for total creatine kinase, CK-MB fraction, troponin T, troponin I, and myoglobin. Three nuclear cardiologists performed blinded image interpretation. Coronary artery disease (CAD) was confirmed either by diagnostic testing or by the occurrence of myocardial infarction (MI). RESULTS: Acute rest MPI results were abnormal in all 9 patients with MI. An additional 26 patients had objective evidence of CAD confirmed by diagnostic testing. The sensitivity of acute rest MPI for objective evidence of CAD was 73%. Serum troponin T and troponin I were highly specific for acute MI but had low sensitivity at presentation. Individual serum markers had very low sensitivity for symptomatic myocardial ischemia alone. In the multivariate regression model, only acute rest MPI and diabetes were independently predictive of CAD. CONCLUSION: At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers.

Biomarkers↗

PubMedDate not supplied

Treatment and prophylaxis of arthropathy in severe hemophilia.

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Blood Transfusion↗

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Hematogenous infection in total joint replacement.

Hematogenous infections may appear at any time after joint replacement operations. As distinguished from delayed infections where general symptoms of infection are absent, hematogenous infections cause malaise, chills and fever, usually of the septic type. Roentgenograms of the joint at an early stage of hematogenous infection do not show any sign of infection as these take time to develop. Nor is the scintigram positive at an early stage. The diagnosis is beyond doubt only when the same strain of bacteria is cultured from the joint, a primary focus and blood.

Adult↗