Potential value of thallium-201 scintigraphy as a means of selecting patients for the coronary care unit.

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Abstract
The potential value of Tl201 scintigraphy to select patients for appropriate coronary care unit admission was evaluated. Studies were made prospectively on 203 patients with possible acute myocardial infarction (AMI) but atypical history and non-diagnostic ECG at a time when the clinical diagnosis was still in doubt. Under conventional circumstances this particular group of patients will be admitted to the coronary care unit for observation to rule out AMI by further clinical evaluation. Scintigraphy was performed upon arrival in the coronary care unit and within 10 h after the last episode of chest pain. Of 203 patients 49 had postivie, 47 had questionable and 107 had normal Tl201 scintiscans. Serial serum enzyme determinations and further clinical follow-up disclosed AMI in 34 patients: all had abnormal scans. Of 47 patients subsequently determined to present with unstable angina, 27 had abnormal scans, 7 subsequently developed AMI. Of 24 patients with previous AMI 18 patients had abnormal scans. The 25 patients with stable angina or the 73 patients with atypical complaints did not show perfusion defects though questionable abnormal scintiscans were obtained in 5 and 12 patients in these groups, respectively. Apparently scintigraphy when performed within a time interval of 10 h after the last episode of chest pain may be of value as a means of selecting those patients requiring further stay in hospital and observation in the coronary care unit.