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| |  New Study Shows Simple Heart Scan Helps Quickly Identify Heart Attack NORTH BILLERICA, Mass., Jan. 7, 1997 -- A non-invasive heart test enables emergency department doctors to safely and more accurately differentiate those patients presenting with chest pain who need intensive cardiac care and costly hospitalization from those who don't, according to a study published in the January edition of the "Annals of Emergency Medicine." An estimated 5 million patients arrive in emergency departments each year suffering from acute chest pain and other symptoms suggesting heart disease. While many of these patients are truly at risk for a heart attack, a high proportion are later found not to require hospitalization. Identifying which patients need intensive cardiac care poses a challenge. About 40 percent of patients with chest pain are admitted to hospitals unnecessarily at an annual cost estimated to be as high as $10-13 billion per year. Despite this routine over-treatment of chest pain, studies show that an estimated 30,000-50,000 heart attack patients are mistakenly sent home from the emergency department without being admitted to the hospital every year. Such diagnostic errors are the major cause of emergency department malpractice claims and account for 20 percent of payouts. Now, however, clinicians at the Virginia Commonwealth University's Medical College of Virginia Hospitals have shown that use of a heart-testing technique called cardiac imaging with Cardiolite(R) (Kit for the Preparation of Technetium Tc99m Sestamibi) as part of systematic emergency department evaluation enables physicians to more accurately diagnose patients whose risk for heart attack status is difficult to assess. These results point to a possible role for more widespread use of acute cardiac perfusion imaging in hospital emergency departments nationwide. The authors studied the experience of 1,187 consecutive emergency department patients with chest pain. Each was assigned to one of five risk levels according to results of the patient's history, physical examination, and electrocardiogram (ECG). Of these, 438 patients at low-to-moderate risk of heart attack were tested with Cardiolite(R). Highlights of the findings include: -- The risk for heart attack or the need for revascularization was significantly higher in patients with abnormal compared to normal tests, further establishing that cardiac imaging with Cardiolite(R) can effectively risk stratify patients in the acute setting. -- The test had a 100 percent accuracy rate (seven out of seven) for detecting heart attacks in patients arriving at the emergency department complaining of chest pains whose combined patient history, physical examination, and ECG had originally suggested that they were at low-to- moderate heart disease risk. -- Two of the seven patients that Cardiolite(R) identified as having heart attacks in the emergency department had been assessed as low risk by patient history, physical examination, and ECG. Cardiac imaging testing was the sole indication that these patients were suffering heart attacks. -- No patients with normal acute resting cardiac imaging tests suffered heart attack or cardiac death during the year following admission. Only three patients with normal tests underwent revascularization procedures in the follow-up year. -- In contrast, during a year's follow up of 100 patients with abnormal acute Cardiolite(R) tests, eight cardiac deaths and four non-fatal heart attacks occurred, and two additional patients underwent revascularization procedures. "There is a mounting body of evidence that heart imaging with sestamibi can help us assess cardiac risk in patients and reduce unnecessary costs," said the study's lead author, James Tatum, MD, Professor of Radiology and Medicine, Chairman of Nuclear Medicine, and Director of Nuclear Cardiology at the Virginia Commonwealth University's Medical College of Virginia Hospitals. "The use of cardiac imaging allows for more effective utilization of resources. We can reduce the chance of inadvertently sending a patient home who appears to be at low risk based on the initial history, physical, and ECG but who is having an acute cardiac event, while we can avoid having to admit patients who really don't need intensive cardiac care." Screened patients received an injection of Cardiolite(R), a radiopharmaceutical that allows doctors to identify portions of the heart receiving reduced blood flow. There have been infrequent reports of signs and symptoms consistent with seizure and severe hypersensitivity after administration of this product. "A systematic approach to chest pain patients should be used in all emergency departments," said study co-author, Robert L. Jesse, MD, Co-Director of the Acute Cardiac Care Program and Coronary Intensive Care Unit, and Assistant Professor of Cardiology Medicine at the Virginia Commonwealth University's Medical College of Virginia Hospitals. "The use of cardiac imaging with sestamibi in moderate- to low-risk patients helps improve the flow of these patients to the appropriate level of care." Cardiolite(R) is marketed by the Radiopharmaceutical Division of The DuPont Merck Pharmaceutical Company. The DuPont Merck Pharmaceutical Company is a worldwide, research-based pharmaceutical and radiopharmaceutical company established in 1991 as a partnership between DuPont and Merck and Co. The company is headquartered in Wilmington, Delaware; the Radiopharmaceutical Division is headquartered in North Billerica, Massachusetts.
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