(American Heart Association) Findings from the Emergency Room Assessment of Sestamibi for Evaluation (ERASE) of chest pain study suggest that the use of a noninvasive heart scan called Cardiolite (kit for the preparation of technetium Tc99m sestamibi for injection) can more accurately rule out myocardial infarction in the emergency department (ED) than standard evaluation techniques and could avoid nearly 250,000 unnecessary hospitalizations for Americans annually. Over a 20-month period, ERASE investigators studied 2,456 patients who presented at seven EDs with symptoms suggestive of a myocardial infarction or unstable angina, but without an obvious pattern of either on their initial electrocardiogram (ECG). One half of all patients were tested with Cardiolite as part of the ED evaluation, while the control group received the usual ED assessment. The patients were ethnically diverse, one half were women, and the average age was 53 years. Of the 2,127 patients whose condition was ultimately diagnosed as noncardiac in origin, patients who received the Cardiolite scan were significantly more likely to be discharged safely from the ED. Use of the Cardiolite scan reduced unnecessary hospitalizations by 20 percent with no increase in hospital discharges among patients actually having a myocardial infarction. The most frequently reported adverse effects from the use of the Cardiolite test include headache, chest pain/angina, ST segment changes on ECG, nausea and abnormal taste and smell. The Cardiolite test has also been rarely associated with acute severe allergic event of angioedema and urticaria.--HARRY P. SELKER, M.D., AND JAMES E. UDELSON, M.D., New England Medical Center, Boston, Massachusetts.
COPYRIGHT 2000 American Academy of Family Physicians
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