Metabolic imaging for identifying antecedent myocardial ischemia and acute coronary syndrome in the emergency department.

摘要

Determining whether a chest pain, which has resolved long before the patient presented to the emergency department, was a consequence of myocardial ischemia can be clinically challenging. Patients presenting with clear electrocardiogram (ECG) changes of ST-segment elevation or depression do not constitute the large majority of those who are ultimately diagnosed with an acute coronary syndrome (ACS). Nearly two thirds of patients presenting to the emergency department with chest pain fall in the low-risk subset, whose overall risk is low, but not negligible [1]. In such patients, achieving an accurate diagnosis for ACS or noncardiac chest pain is hindered by the atypical descriptions of symptoms, equivocal or normal ECG findings, and the delayed time course of serum cardiac biomarkers, which may remain undetectable until several hours after the onset of myocardial infarction. Importantly, cardiac enzymes are not positive in patients with myocardial ischemia.