Reducción de costes mediante gated SPET de perfusión miocárdica precoz en los pacientes con dolor torácico y ECG no diagnóstico en Urgencias Cost reduction using early myocardial perfusion gated SPET in patients with chest pain and non-diagnostic ECG in the Emergency room

Objective: To conduct a cost analysis involving the use of early resting gated SPET in patients with chest pain and non-diagnostic ECG in the Emergency room. Methods: A total of 222 patients (51 females, mean age: 60 ± 12 years) with chest pain and non-diagnostic ECG were randomized into two groups: group A: 111 patients who in addition to conventional management (ECG and CK-MB and troponin I measurements on admission and after four and eight hours) were subjected to early resting gated SPET (< six hours from cessation of pain); group B: 111 patients subjected to conventional management only. Results: Eight patients (7.2%) in group A and six (5.4%) in group B met criteria of acute myocardial infarction based on biochemical markers. The patients without infarctio in grupo A (n: 103) remained fewer hours in the Emergency room than those in group B (13.2 ± 6.9 vs 15.9 ± 8.6, p = 0.004), and required less admissions (13.6% vs 27.6%, p = 0.0013). The economical evaluation made suggest that the diagnosis and treatment of the average patient subjected to gated-SPET in the Emergency room generated an expense of 675 €, as compared to 855 € for patients not subjected to gated-SPET. This implies a reduction of 180 €, basically attributable to the lesser hospital stay in the patients belonging to group A. Conclusions: The cost reduction obtained by the use of early resting gatedSPET in patients with chest pain and non-diagnostic ECG in the Emergency room is consistent with the results reported in other series. Althoug incorporation of the technique involves and added expense, the potential reduction of inappropriate hospitalizations significantly compensates for this.