American Journal of Cardiology
Volume 102, Issue 6 , Pages 649-652 , 15 September 2008

Cost-Efficiency of Myocardial Contrast Echocardiography in Patients Presenting to the Emergency Department With Chest Pain of Suspected Cardiac Origin and a Nondiagnostic Electrocardiogram

Received 14 February 2008 ,Revised 1 May 2008 ,Accepted 1 May 2008.

References 

  1. Tong KL, Kaul S, Wang XQ, Rinkevich D, Kalvaitis S, Belcik T, et al. Myocardial contrast echocardiography versus TIMI score in patients presenting to the emergency department with chest pain and a non-diagnostic electrocardiogram. J Am Coll Cardiol. 2005;46:920–927
  2. Rinkevich D, Kaul S, Lepper W, Wang XQ, Tong KL, Belcik T, et al. Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST segment elevation. Eur Heart J. 2005;26:1606–1611
  3. Kalvaitis S, Kaul S, Rinkevich D, Tong KL, Belcik T, Wei K. Effect of time delay on the diagnostic and prognostic utility of myocardial contrast echocardiography in patients presenting with suspected cardiac chest pain to the emergency department. J Am Soc Echocardiogr. 2006;19:1488–1493
  4. Dawson D, Rinkevich D, Belcik T, Jayaweera AR, Rafter P, Kaul S, et al. Measurement of myocardial blood flow velocity reserve with myocardial contrast echocardiography in patients with suspected coronary artery disease: comparison with quantitative gated 99mTc sestamibi SPECT. J Am Soc Echocardiogr. 2003;16:1171–1177
  5. TreeAge Pro 2006 User's manual. In: Williamstown, MA: TreeAge Software; 2006;p. 16–25
  6. Villanueva FS, Sabia PJ, Afrookteh A, Pollock SG, Hwang LJ, Kaul S. Value and limitations of current methods of evaluating patients presenting to the emergency room with cardiac-related symptoms for determining long-term prognosis. Am J Cardiol. 1992;69::746–750
  7. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335:1342–1349
  8. Luscher MS, Thygesen K, Ravkilde J, Heickendorff L TRIM Study Group. Applicability of cardiac troponin T and I for early risk stratification in unstable coronary artery disease. Circulation. 1997;96:2578–2585
  9. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L. Acute chest pain in the emergency room (Identification and examination of low-risk patients). Arch Intern Med. 1985;145:65–69
  10. McCarthy BD, Beshansky JR, D'Agostino RB, Selker HP. Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med. 1993;22:579–582
  11. Pope JH, Ruthazer R, Beshansky JR, Griffith JL, Selker HP. The clinical presentation of patients with acute cardiac ischemia in the emergency department: a multicenter controlled clinical trial. J Thromb Thrombolysis. 1998;6:63–74
  12. Lee TH, Rouan GW, Weisberg MC, Brand DA, Acampora D, Stasiulewicz C, et al. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol. 1987;60:219–224
  13. Bambha K, Kim WR. Cost-effectiveness analysis and incremental cost-effectiveness ratios: uses and pitfalls. Eur J Gatroenterol Hepatol. 2004;16:519–526
  14. Weinstein MC, Fineberg HV, Ebstein AS, Frazier HS, Heuhauser D, Neutra RR, et al. Clinical decision and limited resources. In: Clinical decision analysis. Philadelphia, PA: Saunders; 1998;p. 228–265
  15. Amsterdam EA, Kirk JD, Diercks DB, Lewis WR, Turnipseed S. Immediate exercise testing to evaluate low risk patients presenting to the emergency department with chest pain. J Am Coll Cardiol. 2002;40:251–256
  16. Stein RA, Chaitman BR, Balady GJ, Fleg JL, Limacher MC, Pina IL, et al. Safety and utility of exercise testing in emergency room chest pain centers (An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association). Circulation. 2000;102:1463–1467
  17. Nucifora G, Badano LP, Sarraf-Zadegan N, Karavidas A, Trocino G, Scaffidi G, et al Comparison of early dobutamine stress echocardiography and exercise electrocardiographic testing for management of patients presenting to the emergency department with chest pain. Am J Cardiol. 2007;100:1068–1073

 This work was supported by a grant from GE Healthcare, Milwaukee, Wisconsin. Dr. Kaul was supported by Grants RO1-HL48890 and RO1-HL66034 from the National Institutes of Health, Bethesda, Maryland, and the American Society of Echocardiography, Raleigh, North Carolina.

PII: S0002-9149(08)00830-8

doi: 10.1016/j.amjcard.2008.05.008

American Journal of Cardiology
Volume 102, Issue 6 , Pages 649-652 , 15 September 2008